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Nishibe H, Tateno A, Sakayori T, Yamamoto M, Kim W, Kakuyama H, Okubo Y. Striatal Dopamine D2 Receptor Occupancy Induced by Daily Application of Blonanserin Transdermal Patches: Phase II Study in Japanese Patients With Schizophrenia. Int J Neuropsychopharmacol 2020; 24:108-117. [PMID: 32936897 PMCID: PMC7883894 DOI: 10.1093/ijnp/pyaa071] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/30/2020] [Accepted: 09/15/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Transdermal antipsychotic patch formulations offer potential benefits, including improved adherence. This study investigated the striatal dopamine D2 receptor occupancy with daily blonanserin transdermal patch application. METHODS This open-label, phase II study enrolled 18 Japanese outpatients (20 to <65 years) with schizophrenia (DSM-IV-TR criteria; total Positive and Negative Syndrome Scale score <120 at screening) treated with blonanserin 8-mg or 16-mg tablets. Patients continued tablets for 2-4 weeks at their current dose and were then assigned to once-daily blonanserin patches (10/20/40/60/80 mg daily) for 2-4 weeks based on the oral dose. [11C]raclopride positron emission tomography scanning determined blonanserin striatal dopamine D2 receptor occupancy (primary endpoint). Secondary endpoints included assessment of receptor occupancy by dose, changes in Positive and Negative Syndrome Scale and Clinical Global Impressions-Severity of Illness-Severity scores, patient attitudes towards adherence, and patch adhesiveness. RESULTS Of 18 patients who started the blonanserin tablet treatment period, 14 patients completed treatment. Mean D2 receptor occupancy for blonanserin tablets 8 mg/d (59.2%, n = 5) and 16 mg/d (66.3%, n = 9) was within the values for blonanserin patches: 10 mg/d (33.3%, n = 3), 20 mg/d (29.9%, n = 2), 40 mg/d (61.2%, n = 3), 60 mg/d (59.0%, n = 3), and 80 mg/d (69.9%, n = 3). Occupancy generally increased with increasing blonanserin dose for both formulations with the half maximal receptor occupancy for tablets and patches associated with doses of 6.9 mg/d and 31.9 mg/d, respectively. Diurnal variability in occupancy was lower during transdermal patch treatment than during tablet treatment. Blonanserin transdermal patches were well tolerated with no major safety concerns. CONCLUSIONS Blonanserin patches (40/80 mg/d) have lower diurnal variability in occupancy than blonanserin tablets (8/16 mg/d), and patches at doses of 40 mg/d and 80 mg/d appear to be a suitable alternative for blonanserin tablets at doses of 8 mg/d and 16 mg/d, respectively. Blonanserin patches represent a potential new treatment option for patients with schizophrenia. TRIAL REGISTRY JAPIC Clinical Trials Information registry (www.clinicaltrials.jp; JapicCTI-No: JapicCTI-121914).
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Affiliation(s)
- Hironori Nishibe
- Clinical Pharmacology Group, Clinical Research, Drug Development Division, Sumitomo Dainippon Pharma Co., Ltd., Tokyo, Japan,Correspondence: Hironori Nishibe, MS, Sumitomo Dainippon Pharma Co., Ltd., 13-1, Kyobashi 1-chome, Chuo-ku, Tokyo 104–8356, Japan ()
| | - Amane Tateno
- Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan
| | - Takeshi Sakayori
- Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan
| | | | - WooChan Kim
- Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan
| | - Hiroyoshi Kakuyama
- Clinical Pharmacology Group, Clinical Research, Drug Development Division, Sumitomo Dainippon Pharma Co., Ltd., Tokyo, Japan
| | - Yoshiro Okubo
- Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan
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Reeves S, McLachlan E, Bertrand J, D'Antonio F, Brownings S, Nair A, Greaves S, Smith A, Taylor D, Dunn J, Marsden P, Kessler R, Howard R. Therapeutic window of dopamine D2/3 receptor occupancy to treat psychosis in Alzheimer's disease. Brain 2017; 140:1117-1127. [PMID: 28334978 DOI: 10.1093/brain/aww359] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/30/2016] [Indexed: 12/31/2022] Open
Abstract
See Caravaggio and Graff-Guerrero (doi:10.1093/awx023) for a scientific commentary on this article.Antipsychotic drugs, originally developed to treat schizophrenia, are used to treat psychosis, agitation and aggression in Alzheimer's disease. In the absence of dopamine D2/3 receptor occupancy data to inform antipsychotic prescribing for psychosis in Alzheimer's disease, the mechanisms underpinning antipsychotic efficacy and side effects are poorly understood. This study used a population approach to investigate the relationship between amisulpride blood concentration and central D2/3 occupancy in older people with Alzheimer's disease by combining: (i) pharmacokinetic data (280 venous samples) from a phase I single (50 mg) dose study in healthy older people (n = 20, 65-79 years); (ii) pharmacokinetic, 18F-fallypride D2/3 receptor imaging and clinical outcome data on patients with Alzheimer's disease who were prescribed amisulpride (25-75 mg daily) to treat psychosis as part of an open study (n = 28; 69-92 years; 41 blood samples, five pretreatment scans, 19 post-treatment scans); and (iii) 18F-fallypride imaging of an antipsychotic free Alzheimer's disease control group (n = 10, 78-92 years), to provide additional pretreatment data. Non-linear mixed effects modelling was used to describe pharmacokinetic-occupancy curves in caudate, putamen and thalamus. Model outputs were used to estimate threshold steady state blood concentration and occupancy required to elicit a clinically relevant response (>25% reduction in scores on delusions, hallucinations and agitation domains of the Neuropsychiatric Inventory) and extrapyramidal side effects (Simpson Angus Scale scores > 3). Average steady state blood levels were low (71 ± 30 ng/ml), and associated with high D2/3 occupancies (65 ± 8%, caudate; 67 ± 11%, thalamus; 52 ± 11%, putamen). Antipsychotic clinical response occurred at a threshold concentration of 20 ng/ml and D2/3 occupancies of 43% (caudate), 25% (putamen), 43% (thalamus). Extrapyramidal side effects (n = 7) emerged at a threshold concentration of 60 ng/ml, and D2/3 occupancies of 61% (caudate), 49% (putamen) and 69% (thalamus). This study has established that, as in schizophrenia, there is a therapeutic window of D2/3 receptor occupancy for optimal treatment of psychosis in Alzheimer's disease. We have also shown that occupancies within and beyond this window are achieved at very low amisulpride doses in Alzheimer's disease due to higher than anticipated occupancies for a given blood drug concentration. Our findings support a central pharmacokinetic contribution to antipsychotic sensitivity in Alzheimer's disease and implicate the blood-brain barrier, which controls central drug access. Whether high D2/3 receptor occupancies are primarily accounted for by age- or disease-specific blood-brain barrier disruption is unclear, and this is an important future area of future investigation, as it has implications beyond antipsychotic prescribing.
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Affiliation(s)
- Suzanne Reeves
- Division of Psychiatry, 149 Tottenham Court Road, London W1T 7NF, University College London, UK.,Department of Old Age Psychiatry, London, SE58AF, Kings College London, UK
| | - Emma McLachlan
- Department of Old Age Psychiatry, London, SE58AF, Kings College London, UK
| | - Julie Bertrand
- UMR 1137 IAME INSERM University Paris 7, France; and Genetics Institute, WC1E6BT, University College London, UK
| | - Fabrizia D'Antonio
- Division of Psychiatry, 149 Tottenham Court Road, London W1T 7NF, University College London, UK.,Department of Old Age Psychiatry, London, SE58AF, Kings College London, UK
| | - Stuart Brownings
- Division of Psychiatry, 149 Tottenham Court Road, London W1T 7NF, University College London, UK
| | - Akshay Nair
- Division of Psychiatry, 149 Tottenham Court Road, London W1T 7NF, University College London, UK
| | - Suki Greaves
- South London and Maudsley NHS Foundation Trust, London, SE58AZ, UK
| | - Alan Smith
- South London and Maudsley NHS Foundation Trust, London, SE58AZ, UK
| | - David Taylor
- South London and Maudsley NHS Foundation Trust, London, SE58AZ, UK
| | - Joel Dunn
- Division of Imaging Sciences, St Thomas Hospital, London, SE17EH, UK
| | - Paul Marsden
- Division of Imaging Sciences, St Thomas Hospital, London, SE17EH, UK
| | | | - Robert Howard
- Division of Psychiatry, 149 Tottenham Court Road, London W1T 7NF, University College London, UK.,Department of Old Age Psychiatry, London, SE58AF, Kings College London, UK
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