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Ricci V, Sarni A, Martinotti G, Maina G. Comparative analysis of third-generation antipsychotics in first-episode schizophrenia: efficacy, safety, and cognitive impacts. A narrative review. Int Clin Psychopharmacol 2024:00004850-990000000-00141. [PMID: 38941160 DOI: 10.1097/yic.0000000000000559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
BACKGROUND AND OBJECTIVES Schizophrenia is a chronic, complex mental health disorder requiring effective management to mitigate its broad personal and societal impacts. This narrative review assesses the efficacy, effectiveness, and side effects of third-generation antipsychotics (TGAs) like aripiprazole, brexpiprazole, and cariprazine, focusing on their use in first-episode schizophrenia. These drugs aim to reduce side effects typical of earlier antipsychotics while more effectively addressing positive and cognitive symptoms. METHODS Our extensive literature review, using PubMed and Scopus, includes randomized controlled trials and observational studies, showing TGAs may match older antipsychotics in efficacy with fewer side effects, notably in reducing extrapyramidal symptoms and enhancing cognitive outcomes. RESULTS Aripiprazole appears effective in both acute and maintenance phases of schizophrenia, while brexpiprazole and cariprazine show potential in managing negative symptoms and improving social functioning, essential for patient recovery. CONCLUSIONS This review emphasizes the need for personalized treatment and further research to fully determine the long-term benefits and safety of TGAs. These findings can inform clinical decisions and underline the ongoing need for innovation in schizophrenia pharmacotherapy.
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Affiliation(s)
- Valerio Ricci
- Department of Psychiatry, San Luigi Gonzaga Hospital, University of Turin, Orbassano
| | - Alessandro Sarni
- Department of Psychiatry, San Luigi Gonzaga Hospital, University of Turin, Orbassano
| | - Giovanni Martinotti
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio Chieti-Pescara, Chieti and
| | - Giuseppe Maina
- Department of Psychiatry, San Luigi Gonzaga Hospital, University of Turin, Orbassano
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Torino, Italy
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Selvan P, Devkare P, Shetty A, Dharmadhikari S, Khandhedia C, Mane A, Mehta S, Andrade C. A review on the pharmacology of cariprazine and its role in the treatment of negative symptoms of schizophrenia. Front Psychiatry 2024; 15:1385925. [PMID: 38711874 PMCID: PMC11071166 DOI: 10.3389/fpsyt.2024.1385925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/29/2024] [Indexed: 05/08/2024] Open
Abstract
Management of negative symptoms is one of the most challenging and important unmet needs of schizophrenia treatment. Negative symptoms together with positive symptoms result in significant psychosocial impairment and poor quality of life. Existing studies on atypical antipsychotics reported limited treatment adherence due to higher prevalence of treatment-emergent adverse events, such as diabetes, weight gain, hyperlipidemia, hyperprolactinemia and hypertension. A compound with greater affinity for dopamine D2/D3 receptors may improve negative symptoms, mood, and cognitive impairment associated with schizophrenia. In 2015, the US FDA has approved cariprazine, a partial D2/D3 agonist for treatment of schizophrenia, mania or mixed episodes. Midlands and Lancashire Commissioning Support Unit, UK (2019) has particularly suggested cariprazine for the treatment of predominant negative symptoms of schizophrenia. India's Central Drugs Standard Control Organization (CDSCO) has approved cariprazine in 2021 for the treatment of schizophrenia, manic or mixed episodes associated with bipolar I disorder. A ten-fold greater affinity for D3 receptors and partial agonism to serotonin receptors, along with longer half-life make cariprazine distinct when compared with other atypical antipsychotics. Cariprazine is also reported to have fewer incidents of metabolic and hormonal adverse events, and has been shown to provide better relapse prevention. Recent evidence indicates promising effect of cariprazine in ameliorating negative symptoms as well as psychotic symptoms in patients with schizophrenia. In addition, improved adherence to treatment (adjunctive/monotherapy) with cariprazine in patients having inadequate response to an ongoing antipsychotic treatment has also been clinically established. This review presents the evidence-based safety and efficacy of cariprazine for treatment of predominant negative symptoms of schizophrenia.
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Affiliation(s)
- Panneer Selvan
- Department of Psychiatry, Sneka Mind Care Hospital, Tirunelveli, Tamil Nadu, India
| | - Prashant Devkare
- Medical Affairs and Clinical Research, Sun Pharmaceutical Industries Limited, Mumbai, India
| | - Arthik Shetty
- Medical Affairs and Clinical Research, Sun Pharma Laboratories Limited, Mumbai, India
| | - Shruti Dharmadhikari
- Medical Affairs and Clinical Research, Sun Pharma Laboratories Limited, Mumbai, India
| | - Chintan Khandhedia
- Medical Affairs and Clinical Research, Sun Pharma Laboratories Limited, Mumbai, India
| | - Amey Mane
- Medical Affairs and Clinical Research, Sun Pharma Laboratories Limited, Mumbai, India
| | - Suyog Mehta
- Medical Affairs and Clinical Research, Sun Pharma Laboratories Limited, Mumbai, India
| | - Chittaranjan Andrade
- Department of Clinical Psychopharmacology and Neurotoxicology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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Balicza P, Gezsi A, Fedor M, Sagi JC, Gal A, Varga NA, Molnar MJ. Multilevel evidence of MECP2-associated mitochondrial dysfunction and its therapeutic implications. Front Psychiatry 2024; 14:1301272. [PMID: 38250256 PMCID: PMC10796460 DOI: 10.3389/fpsyt.2023.1301272] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/22/2023] [Indexed: 01/23/2024] Open
Abstract
We present a male patient carrying a pathogenic MECP2 p. Arg179Trp variant with predominant negative psychiatric features and multilevel evidence of mitochondrial dysfunction who responded to the cariprazine treatment. He had delayed speech development and later experienced severe social anxiety, learning disabilities, cognitive slowing, and predominant negative psychiatric symptoms associated with rigidity. Clinical examinations showed multisystemic involvement. Together with elevated ergometric lactate levels, the clinical picture suggested mitochondrial disease, which was also supported by muscle histopathology. Exploratory transcriptome analysis also revealed the involvement of metabolic and oxidative phosphorylation pathways. Whole-exome sequencing identified a pathogenic MECP2 variant, which can explain both the dopamine imbalance and mitochondrial dysfunction in this patient. Mitochondrial dysfunction was previously suggested in classical Rett syndrome, and we detected related phenotype evidence on multiple consistent levels for the first time in a MECP2 variant carrier male. This study further supports the importance of the MECP2 gene in the mitochondrial pathways, which can open the gate for more personalized therapeutic interventions. Good cariprazine response highlights the role of dopamine dysfunction in the complex psychiatric symptoms of Rett syndrome. This can help identify the optimal treatment strategy from a transdiagnostic perspective instead of a classical diagnostic category.
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Affiliation(s)
- Peter Balicza
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
- Eotvos Lorand Research Network, Multiomic Neurodegeneration Research Group, Budapest, Hungary
| | - Andras Gezsi
- Department of Measurement and Information Systems, Budapest University of Technology and Economics, Budapest, Hungary
| | - Mariann Fedor
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Judit C. Sagi
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Aniko Gal
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Noemi Agnes Varga
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Maria Judit Molnar
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
- Eotvos Lorand Research Network, Multiomic Neurodegeneration Research Group, Budapest, Hungary
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Pappa S, Kalniunas A, Maret J. Cariprazine for negative symptoms in early psychosis: a pilot study with a 6-month follow-up. Front Psychiatry 2023; 14:1183912. [PMID: 37426095 PMCID: PMC10323827 DOI: 10.3389/fpsyt.2023.1183912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/07/2023] [Indexed: 07/11/2023] Open
Abstract
Background Cariprazine, a novel antipsychotic drug that is a partial agonist with preferential binding to the D3 receptor, has demonstrated efficacy in clinical trials across all symptom domains, including negative symptoms, which can occur early in the course of psychotic illness. However, evidence, to date regarding its effects in early psychosis patients with primary negative symptoms has been limited. Objectives To evaluate the efficacy of cariprazine for negative symptoms in early psychosis patients. Methods Demographic and clinical information of the study population were collected from the electronic records and PANSS scale administered at baseline, 3 and 6 months. Tolerability and discontinuation reasons, where applicable, were also recorded. Results Ten patients with early psychosis (four men and six women, mean age - 25.5 years) with prominent or predominant negative symptoms were treated with cariprazine (range 1.5 - 3 mg). Three patients discontinued cariprazine within the first 3 months due to patient choice, lack of response and non-compliance, respectively. In the remaining patients, there was a significant reduction in the mean negative PANSS score from baseline to 6 months (from 26.3 to 10.6), mean total PANSS score (from 81.4 to 43.3) and in the mean positive PANSS score (from 14.4 to 9.9) which correspond to a 53.1, 41.5, and 28.5% mean score reduction. Conclusion This pilot study suggests that cariprazine is a safe and effective treatment in early psychosis, particularly for the alleviation of negative symptoms which remains an area of unmet treatment need.
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Affiliation(s)
- Sofia Pappa
- West London NHS Trust, London, United Kingdom
- Imperial College London, London, United Kingdom
| | - Arturas Kalniunas
- West London NHS Trust, London, United Kingdom
- Greater Manchester Mental Health NHS Trust, Manchester, United Kingdom
| | - Jose Maret
- West London NHS Trust, London, United Kingdom
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Morozov P, Bekker R, Bykov Y. Cariprazine's Potential in Improving Social Dysfunction in Patients With Schizophrenia: A Perspective. Front Psychiatry 2022; 13:868751. [PMID: 35573354 PMCID: PMC9091654 DOI: 10.3389/fpsyt.2022.868751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/21/2022] [Indexed: 11/25/2022] Open
Abstract
Social dysfunction is one of the most debilitating aspects of schizophrenia. Treatment of this complex phenomenon, constituted by negative, cognitive, and affective symptoms, has been difficult with the available pharmacological agents, hence it represents an unmet medical need. Cariprazine, a novel, third-generation antipsychotic with a unique mechanism of action has been proven to sufficiently alleviate negative, cognitive, and affective symptoms of schizophrenia. These characteristics make this compound a valid candidate for addressing social dysfunction too. In this perspective, we argue that cariprazine can be viewed as a "socializing drug" that has the ability to improve the patient's functionality and ultimately their quality of life. Data from animal research, clinical trials, an observational study, and patient cases are provided.
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Affiliation(s)
- Petr Morozov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Roman Bekker
- Ben-Gurion University of the Negev, Beersheba, Israel
| | - Youri Bykov
- Stavropol State Medical University, Stavropol, Russia
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Csehi R, Dombi ZB, Sebe B, Molnár MJ. Real-Life Clinical Experience With Cariprazine: A Systematic Review of Case Studies. Front Psychiatry 2022; 13:827744. [PMID: 35370825 PMCID: PMC8970284 DOI: 10.3389/fpsyt.2022.827744] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/15/2022] [Indexed: 11/24/2022] Open
Abstract
Background The hierarchy of evidence coming from evidence-based medicine favors meta-analyses and randomized controlled trials over observational studies and clinical cases. Nonetheless, in the field of psychiatry, where conditions are much more complex, additional evidence coming from real-world clinical practice is necessary to complement data from these gold standards. Thus, in this systematic review, the aim is to summarize the evidence coming from clinical case reports regarding cariprazine, a third-generation antipsychotic drug that has been approved for the treatment of schizophrenia and bipolar I disorder with manic, depressive or mixed features in adults. Methods A systematic review was performed using Embase and Pubmed databases searching for English-language cases published in peer-reviewed journals between 2000 January and 2021 September with the following search terms: (cariprazin* OR "rgh-188" OR rgh188 OR vraylar OR reagila) AND ("case report*" OR "case report"/de OR "case stud*" OR "case study"/de OR "case seri*"). Results After the removal of duplicates, 49 articles were retrieved via the search, from which 22 were suitable for this review. These 22 articles encompassed 38 cases from which 71% described patients with schizophrenia, 16% patients with psychotic disorders, 5% patients with mood disorder and 8% described patients with other disorders such as Wernicke-Korsakoff syndrome, borderline personality disorder and obsessive-compulsive disorder with paranoid schizophrenia. The median age of patients was 31, and half of them were female. The majority of patients (76%) started cariprazine with 1.5 mg/day, and the most common maintenance dose was 4.5 mg/day (34%) and 3.0 mg/day (29%). Conclusion Cariprazine was found to be safe and effective in a wide range of psychiatric conditions with different symptom profiles from acute psychotic symptoms through addiction to negative and cognitive symptoms. The results are in-line with the established evidence from clinical trials, however, they also show how cariprazine can be successfully utilized for treating certain symptoms irrespective of the indication.
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Affiliation(s)
- Réka Csehi
- Global Medical Division, Gedeon Richter Plc, Budapest, Hungary
| | - Zsófia Borbála Dombi
- Global Medical Division, Gedeon Richter Plc, Budapest, Hungary
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Barbara Sebe
- Global Medical Division, Gedeon Richter Plc, Budapest, Hungary
| | - Mária Judit Molnár
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
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Rancans E, Dombi ZB, Barabássy Á. Dosing Cariprazine Within and Beyond Clinical Trials: Recommendations for the Treatment of Schizophrenia. Front Psychiatry 2022; 12:770234. [PMID: 35069278 PMCID: PMC8768837 DOI: 10.3389/fpsyt.2021.770234] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/19/2021] [Indexed: 01/13/2023] Open
Abstract
Although the optimal dosing of an antipsychotic medication is known to be essential in the long-term management of schizophrenia, in case of novel drugs such as cariprazine, determining the right dosing strategy is not that simple. Without decades of experience with a particular compound, evidence regarding dosing and titration comes primarily from double-blind, placebo controlled clinical trials that are not necessarily mirroring the real-life experiences of doctors. Via summarizing data from both clinical data (n = 3275) and real-world evidence (observational study n = 116, case studies n = 29), this perspective paper aims to shed a light on the appropriate dosing strategies of cariprazine from treatment initiation through switching strategies to concomitant medications.
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Affiliation(s)
- Elmars Rancans
- Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia
| | - Zsófia Borbála Dombi
- Gedeon Richter Plc., Medical Division, Budapest, Hungary
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Viegas F, Ferreira T, Campos C. Using Cariprazine to Ameliorate Negative Symptoms and Metabolic Side Effects of Clozapine and Paliperidone - Clinical Cases. Neuropsychiatr Dis Treat 2022; 18:1145-1149. [PMID: 35712695 PMCID: PMC9192349 DOI: 10.2147/ndt.s343747] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 05/31/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Cariprazine is a third-generation antipsychotic approved in Europe in 2017 for the treatment of schizophrenia. It presents distinct pharmacodynamic properties, such as D3/D2 partial agonism, preferential binding to D3 receptors, antagonism at the serotonin 5-HT2A and 5-HT2B receptors, partial agonism at 5-HT1A receptors, and low affinity to other receptors (including noradrenergic, histaminergic, and cholinergic). It has demonstrated efficacy in the treatment of positive and negative symptoms of schizophrenia with a safe side effect and metabolic profile. METHODS Here, we describe one clinical case of a patient that benefited from an add-on of cariprazine to a regimen of clozapine; and two clinical cases of patients that benefited from the switch from clozapine and paliperidone long-acting injectable to cariprazine. RESULTS AND DISCUSSION Those cases illustrate how cariprazine can be used in patients with schizophrenia in the treatment of both positive and negative symptoms, and when aiming to ameliorate the metabolic burden associated with other treatments. However, further studies are needed to consubstantiate those findings.
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Affiliation(s)
- Filipa Viegas
- Mental Health Department Hospital Prof. Dr. Fernando Fonseca, Amadora, Portugal
| | - Tiago Ferreira
- Mental Health Department Hospital Prof. Dr. Fernando Fonseca, Amadora, Portugal
| | - Cláudia Campos
- Mental Health Department Hospital Prof. Dr. Fernando Fonseca, Amadora, Portugal
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Németh G, Dombi ZB, Laszlovszky I, Barabássy Á. Addressing negative symptoms of schizophrenia pharmacologically with cariprazine: evidence from clinical trials, a real-world study, and clinical cases. Expert Opin Pharmacother 2021; 23:1467-1468. [PMID: 34431422 DOI: 10.1080/14656566.2021.1968827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- György Németh
- Gedeon Richter Plc, Medical Division, Budapest, Hungary
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Reznik AM, Arbuzov AL, Murin SP. Negative Symptoms of Schizophrenia: New Prospects of Cariprazine Treatment. CONSORTIUM PSYCHIATRICUM 2020; 1:43-51. [PMID: 39006904 PMCID: PMC11240126 DOI: 10.17650/2712-7672-2020-1-2-43-51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/21/2020] [Indexed: 07/16/2024] Open
Abstract
Background Cariprazine is a new piperazine derivative atypical antipsychotic, like aripiprazole and brexpiprazole. It has been approved for treating schizophrenia in many countries and has recently been included on the List of Essential Medicines in Russia. Unlike most other atypical antipsychotics, it shows high in vivo occupancy of dopamine D2 and D3 receptors at clinically relevant doses. In animal models, cariprazine has demonstrated dopamine D3 receptor-dependent pro-cognitive and anti-anhedonic effects, suggesting its potential for treating negative symptoms. This review summarizes the efficacy of cariprazine in the treatment of negative symptoms of schizophrenia. Methods A literature search of databases covering international and Russian journals, for articles published between 1st January 2010 and 1st June 2020. Results Cariprazine demonstrated at least comparable efficacy in the treatment of schizophrenia symptoms to active comparators including risperidone, olanzapine or aripiprazole. The drug has a good safety profile. It appeared to be associated with a lower risk of metabolic syndromes and most extrapyramidal symptoms. The positive effect of cariprazine on the negative symptoms of schizophrenia may be associated with the elimination of secondary negative symptoms. However, of all the atypical antipsychotics to date, only cariprazine has a convincingly, methodologically robust proven advantage over risperidone in eliminating the predominant negative symptoms of schizophrenia. Yet only four studies have investigated the effect of cariprazine on the negative symptoms of schizophrenia. There is a lack of research into its direct impact on emotional-volitional disorders, anhedonia, cognitive symptoms and personality changes. However, there is evidence to suggest cariprazine is effective in treatment-resistant cases, but this requires further confirmation. Conclusion Cariprazine is an effective and well-tolerated agent for the treatment of schizophrenia and may be effective in cases where other antipsychotics have failed. Cariprazine has been shown to have a positive effect on negative symptoms. Further studies are needed to collect more data on long-term treatment of schizophrenia and especially negative symptoms.
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Affiliation(s)
- Aleksandr M Reznik
- Medical Institute of Continuing Education of «Moscow National University of Food Production»
- Mental-health Clinic No. 1 named after N.A. Alexeev
| | - Aleksandr L Arbuzov
- Medical Institute of Continuing Education of «Moscow National University of Food Production»
- Mental Health Clinic No. 5
| | - Sergey P Murin
- Medical Institute of Continuing Education of «Moscow National University of Food Production»
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