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

Rancāns, Elmārs; Dombi, Zsófia Borbála; Born, Christoph

doi:10.3389/fpsyt.2021.770234

Cited by 11 publications

(11 citation statements)

References 45 publications

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“…This dosing strategy is recommended by the summary of product characteristics (SmPC) ( 5 ) and by other expert opinion panels as well ( 56 ). Recently, an article by Rancans and colleagues summarized the evidence regarding cariprazine dosing and came to similar conclusions ( 57 ).…”

Section: Discussionmentioning

confidence: 80%

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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Section: Discussionmentioning

confidence: 80%

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

et al. 2022

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“…In all three cases, treatment switching was carried out on an outpatient basis in a mental health day center. Careful titration is recommended when switching from clozapine 22 , 23 due to the risk of cholinergic rebound or worsening psychotic symptoms, as exemplified in the third case. There are two titration strategies for initiating treatment with cariprazine: one slow and one fast.…”

Section: Discussionmentioning

confidence: 99%

“…There are two titration strategies for initiating treatment with cariprazine: one slow and one fast. 23–25 The slow method consists of weekly increases of 1.5 mg, while the fast method consists of daily or every second-day increases of 1.5 mg until reaching a dose that is effective and produces minimal adverse effects. The maximum recommended dose for schizophrenia is 6 mg per day.…”

Section: Discussionmentioning

confidence: 99%

“…24 , 25 Above this dose, the benefits are minimal, and the risk of adverse effects increases significantly. 23 , 24 , 26 In the first two cases, the slow method was used, while in the third case, the fast method was implemented, although increases were made every other day and not every day. In all cases, the implementation of the treatment was well tolerated.…”

Section: Discussionmentioning

confidence: 99%

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Switching Clozapine to Cariprazine in Three Patients with Persistent Symptoms of Schizophrenia: A Case Series

Duque-Yemail¹,

Avila²

2022

NDT

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Despite many available treatments for schizophrenia, several unmet needs persist in treating individuals with this disorder, and the response rate to first-line antipsychotics remains relatively low. Clozapine has shown efficacy in treating schizophrenia patients who failed to respond to previous antipsychotics. However, side effects and the need for routine blood tests have limited its use as a first-line treatment. Cariprazine is a D 2 /D 3 partial agonist antipsychotic with a mechanism of action that differs from other antipsychotics due to its higher affinity for D 3 receptors. Several trials have demonstrated the efficacy of cariprazine on positive and negative symptoms of schizophrenia and have shown that it is a well-tolerated treatment. In this series, we present 3 cases of patients diagnosed with schizophrenia who were initially under treatment with clozapine. Despite some initial improvement, the patients showed persisting positive and negative symptoms or developed limiting side effects while in treatment with clozapine. Cariprazine treatment was titrated concurrently with clozapine tapering until its discontinuation. Significant improvement in both positive and negative symptoms was observed up to 14 months after starting cariprazine, and resolution of side effects was reported in all cases. Our case series supports cariprazine as an effective treatment for positive and negative symptoms in patients who failed to adequately respond or poorly tolerated treatment with clozapine, as well as a potential treatment in dual disorders, specifically psychotic disorders and cocaine use disorder.

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“…At age 44 (year 2019) – after recurrent persuasion – the patient accepted a treatment trial with CAR. CAR treatment was started with 1.5 mg per day for 4 days, followed by 3 mg per day for 12 days, after which the dose was raised to 4.5 mg per day [slow titration strategy ( 10 )]. The patient reported no side effects and no adverse reactions were observed.…”

Section: Case Presentationmentioning

confidence: 99%

Remission of Persistent Negative Symptoms and Psychosocial Consequences by Combined Clozapine and Cariprazine Treatment in a Patient With Long-Standing Treatment-Resistant Schizoaffective Disorder

Bogren

Soltesz²,

Stephan³

2022

Front. Psychiatry

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This patient case report describes a 45-year old white unmarried man with disability pension due to schizoaffective disorder, diagnosed at the age of 24. He lives in an apartment and has housing support. Retrospectively, the patient displayed prodromal markers of a disorder within the schizophrenia spectrum many years before the onset of frank psychosis, indeed since childhood. Over the years several symptoms and signs across schizophrenia domains have been manifest: positive, negative, cognitive, and affective, among which the negative and affective symptoms and signs were the earliest to appear. While the positive, disorganized, and catatonic symptoms responded to treatment – when duly tested and complied with – the negative and affective symptoms have been notoriously difficult to handle. We now report on the successful introduction of cariprazine (CAR) to his ongoing clozapine (CLZ) medication, the result of which has been a near-complete remission of his persistent negative and psychosocial issues. We interpret this remarkable alleviation of the patient's disease – and concomitant improvement of his quality of life – in terms of neuroreceptor target complementarity between CLZ and CAR, with particular emphasis on the contributions from the D3 and D2 receptor partial agonist components of the latter agent.

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

Cited by 11 publications

References 45 publications

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

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

Switching Clozapine to Cariprazine in Three Patients with Persistent Symptoms of Schizophrenia: A Case Series

Remission of Persistent Negative Symptoms and Psychosocial Consequences by Combined Clozapine and Cariprazine Treatment in a Patient With Long-Standing Treatment-Resistant Schizoaffective Disorder

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