Cariprazine for negative symptoms in early psychosis: a pilot study with a 6-month follow-up

Abstract

BackgroundCariprazine, 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.ObjectivesTo evaluate the efficacy of cariprazine for negative symptoms in early psychosis patients.MethodsDemographic 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.ResultsTen 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.ConclusionThis 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.

A 12-month longitudinal naturalistic follow-up of cariprazine in schizophrenia

“…In addition, our study also investigated the occurrence of extrapyramidal effects during cariprazine treatment in the sample at the 6-month follow-up. The data from our study are consistent with those already available in the literature (21,22,24,25,32,33), substantially showing good tolerability of cariprazine, with extrapyramidal symptoms occurred in a minority of patients and in mild or mild or moderate forms: no patient showed moderate forms of psychic/motor akathisia or dystonia and only three subjects showed moderate parkinsonism. A lower prevalence of akathisia has been reported in cariprazine treatment with respect to other antipsychotic treatments (32).…”

“…Similar results emerged when comparing the PANSS-derived Marder factors across assessment time points of the study, with significant symptoms' improvement evidenced by the significant reduction in scores, both between T0 and T1 (6-month follow-up) and between T0 and T2 (12-month follow-up) for each of the factors (positive symptoms, disorganized thoughts, negative symptoms, hostility/excitement, anxiety/depression). These results are consistent with data from the literature showing that cariprazine appear to have a good efficacy profile in a wide range of symptoms of schizophrenia (8,13,14,(20)(21)(22)(23)(24)(25)(26). Further, a recent study provided support for the notion that cariprazine in high dosages might be a well-tolerated and effective treatment option for acute patients on the schizophrenia spectrum in real-life as well (27).…”

A review on the pharmacology of cariprazine and its role in the treatment of negative symptoms of schizophrenia

“…The NNT of cariprazine is lower than risperidone (n=3 vs. 6) and aripiprazole (n=3 vs. 19) in achieving PANSS factor score for negative symptoms, suggesting that cariprazine dose of 1.5–3 mg/day is sufficient to accomplish positive outcomes than risperidone and aripiprazole ( 26 ). A small uncontrolled, open label study in patients with early psychosis found that the mean negative PANSS score decreased from 26 (at baseline) to 11 (at 6 months) in patients who tolerated cariprazine (1.5-3.0 mg/day) and responded to it ( 78 ). Treatment-resistant or drug-naïve schizophrenia has shown improvement with cariprazine treatment ( 1 , 75 ).…”