Practical Guidance on the Use of Lurasidone for the Treatment of Adults with Schizophrenia

Abstract

IntroductionLurasidone is an atypical antipsychotic that was approved in Europe in 2014 for the treatment of schizophrenia in adults aged ≥ 18 years. Clinical experience with lurasidone in Europe is currently limited, and there is therefore a need to provide practical guidance on using lurasidone for the treatment of adults with schizophrenia.MethodsA panel of European psychiatrists with extensive experience of prescribing lurasidone was convened to provide recommendations on using lurasidone to treat adults with schizophrenia.ResultsExtensive evidence from clinical trials and the panel’s clinical experience suggest that lurasidone is as effective as other atypical agents, with the possible exception of clozapine. Lurasidone is associated with a lower propensity for metabolic side effects (in particular, weight gain) and hyperprolactinaemia than most other atypical antipsychotics and has a relatively benign neurocognitive side effect profile. Patients switching to lurasidone from another antipsychotic may experience weight reduction and/or improvements in the ability to focus/concentrate. Most side effects with lurasidone (such as somnolence) are transitory, easily managed and/or ameliorated by dose adjustment. Akathisia and extrapyramidal symptoms may occur in a minority of patients, but these can be managed effectively with dose adjustment, adjunctive therapy and/or psychosocial intervention.ConclusionsGiven the crucial importance of addressing the physical as well as mental healthcare needs of patients, lurasidone is a rational therapeutic choice for adults with schizophrenia, both in the acute setting and over the long term.FundingSunovion Pharmaceuticals Europe Ltd.Electronic supplementary materialThe online version of this article (10.1007/s40120-019-0138-z) contains supplementary material, which is available to authorized users.

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“… 5 Expert consensus guidelines recommend lowering the dosage of the DRBA, switching to an antipsychotic carrying lower akathisia risk (such as quetiapine), or initiating a short-term adjunctive medication as initial treatment options for DRBA-A. 90 – 92 If it is safe to do so, decreasing the dose by 50% or completely discontinuing the DRBA may be required to relieve symptoms of akathisia. 31 If medications are used to treat DRBA-A, response rates for the commonly used agents propranolol and mirtazapine have been found to be 30% and 43.3%, respectively.…”

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“…Lurasidone is an atypical antipsychotic with high affinity for dopamine D2 receptors, noradrenaline alpha-2C receptors, and serotonin 5-HT2A, 5-HT1A, and 5HT7 receptors [ 222 , 250 , 251 ]. A study of 2373 patients with acute schizophrenia found lurasidone was safe and effective, especially with a daily dose of 80 mg [ 251 ].…”

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“…Lurasidone is a novel atypical antipsychotic, which has been approved in Europe only for the treatment of schizophrenia in adults; in the United States, it is also used for the treatment of bipolar depression in adults, as monotherapy and as adjunctive therapy with lithium or valproate. 10 Our patient presented with a composite clinical picture, with a wide variety of symptoms: on 1 hand, she had disorganized poor speech and delusions, which might be attributable to psychotic-like state; on the other hand, her mood was depressed with dysphoric notes, typical of bipolar depression. In fact, lurasidone seems to exert positive effects on psychotic-like symptoms, mood, and cognition.…”

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