Cariprazine: Patients with Treatment-Resistant Schizophrenia

Aubel, Thomas

doi:10.2147/ndt.s315653

Cited by 16 publications

(28 citation statements)

References 21 publications

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“… 38 – 45 As can be seen in Table 2 , clozapine augmentation with cariprazine for negative symptoms has not been widely studied, with evidence limited to case reports and case series. 28 , 46 Nevertheless, the current evidence provides ground for cautious optimism. Consistent with our study, a recent case series by Berardis et al demonstrated the effectiveness of cariprazine in combination with clozapine for the treatment of residual negative symptoms.…”

Section: Discussionmentioning

confidence: 95%

Clozapine augmentation with cariprazine for negative symptoms: a case series and literature review

Oloyede

Clark

Mace

et al. 2022

Therapeutic Advances in Psychopharmacology

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Only about 50% of patients with treatment-resistant schizophrenia respond to clozapine, and many more patients continue to experience ongoing and prominent negative symptoms. These negative symptoms, for which there are limited pharmacological options, may represent the greatest barrier to functional recovery. Cariprazine is a novel antipsychotic drug that is a partial agonist at dopamine D2 and D3 receptors with preferential binding to the D3 receptor, antagonism of 5HT2B receptors, and partial agonism at 5HT1A receptors. Cariprazine is currently licenced for the treatment of schizophrenia in Europe and the United States and has also been approved for bipolar disorder in the United States. There is a limited body of evidence to suggest clinical effectiveness as an augmentation strategy for negative symptoms in those treated with clozapine. In this case series, we present five cases of successful treatment of negative symptoms by clozapine combined with cariprazine in treatment-resistant psychosis.

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Section: Discussionmentioning

confidence: 95%

Clozapine augmentation with cariprazine for negative symptoms: a case series and literature review

Oloyede

Clark

Mace

et al. 2022

Therapeutic Advances in Psychopharmacology

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“…Many patients experienced intolerable side effects induced by other antipsychotics, therefore cariprazine was initiated due to its favorable safety profile. Three patients experienced psychomotor retardation ( n = 3), and in case of one patient ( case 2 ) ( 35 ), it got so severe that she became fully bedridden. Furthermore, weight gain ( n = 3) and the development of metabolic syndrome ( n = 3) were problematic for patients; one of them ( case 15 ) ( 42 ) gained 30 kg after the first year of taking olanzapine, causing increases in triglyceride and cholesterol levels.…”

Section: Resultsmentioning

confidence: 99%

Real-Life Clinical Experience With Cariprazine: A Systematic Review of Case Studies

et al. 2022

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BackgroundThe 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.MethodsA 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*”).ResultsAfter 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%).ConclusionCariprazine 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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“…In case of cariprazine, switching from another antipsychotic can be beneficial if there has been no or only partial response to positive or negative symptoms (27,31,32,35,37,41,43), if the patient suffers from side effects (27,(34)(35)(36)42) that are less common with cariprazine such as weight gain, hyperprolactinemia, sexual disturbance or sedation (44) or if the patients has been prone to non-adherence or substance abuse (29,35).…”

Section: Switching From Another Antipsychotic To Cariprazinementioning

confidence: 99%

“…Fast titration involves an increase of 1.5 mg/day each day or every second day until the target dose is achieved, as seen in the short-term clinical trials ( 20 , 21 , 23 ). This or similar strategy was utilized in several cases ( 31 , 33 – 35 , 37 , 40 , 41 , 43 ), where 3.0 mg/day dose was introduced within less than a week after the beginning of the treatment. In these cases, most of the patients exhibited considerable psychotic symptoms with or without negative symptoms and weight gain problems caused by previous medication.…”

Section: Cariprazine a Third-generation Antipsychotic Agentmentioning

confidence: 99%

Dosing Cariprazine Within and Beyond Clinical Trials: Recommendations for the Treatment of Schizophrenia

2022

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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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Cariprazine: Patients with Treatment-Resistant Schizophrenia

Cited by 16 publications

References 21 publications

Clozapine augmentation with cariprazine for negative symptoms: a case series and literature review

Clozapine augmentation with cariprazine for negative symptoms: a case series and literature review

Real-Life Clinical Experience With Cariprazine: A Systematic Review of Case Studies

Dosing Cariprazine Within and Beyond Clinical Trials: Recommendations for the Treatment of Schizophrenia

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