The efficacy of cariprazine on function in patients with bipolar depression: a 
            <i>post hoc</i>
            analysis of a randomized controlled trial

Vieta, Eduard; Calabrese, Joseph R.; Whelan, Jessica; Tohen, Mauricio; Earley, Willie

doi:10.1080/03007995.2021.1932446

Cited by 19 publications

(8 citation statements)

References 49 publications

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“…Moreover, CAR is the only antipsychotic with proven superiority over another antipsychotic in the treatment of predominant negative symptoms, including anhedonia, avolition-apathy, and alogia (28). Furthermore, there are post-hoc analyses demonstrating improvement of cognitive dysfunction in different psychiatric disorders after CAR treatment (29)(30)(31)(32). indications: mitochondrial encephalomyopathy and lactic acidosis (MELAS syndrome) due to the mutation m.A3243G where the predominantly negative symptoms and cognitive dysfunction improved (33); substance use disorder (e.g., cocaine, alcohol, methamphetamine) (34,35); obsessive-compulsive disorder as add-on therapy (36) and borderline personality disorder (37).…”

Section: Discussionmentioning

confidence: 99%

Improving Mood and Cognitive Symptoms in Huntington's Disease With Cariprazine Treatment

Molnár

Fedor

et al. 2022

Front. Psychiatry

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In Huntington's disease (HD), the main clinical symptoms include depression, apathy, cognitive deficits, motor deficiencies and involuntary movements. Cognitive, mood and behavioral changes may precede motor symptoms by up to 15 years. The treatment of these diverse symptoms is challenging. Tetrabenazine and deutetrabenazine are the only medications specifically approved for Huntington's chorea, but they do not affect the non-motor symptoms. For these, antidepressants, antipsychotics, and benzodiazepines have demonstrated benefit in some cases and can be used off-label. These drugs, due to sedative side effects, may negatively influence cognition. Sixteen patients having HD received a 12-week off-label cariprazine (CAR) treatment (1.5–3 mg/day). Cognitive performance and behavioral changes were measured by the Addenbrooke Cognitive Examination (ACE) test, the Cognitive and Behavioral part of the Unified Huntington's Disease Rating Scale (UHDRS), and the Beck Depression Inventory (BDI). Mixed model for repeated measures was fitted to the data, with terms of visit, baseline (BL) and their interaction. Cariprazine treatment resulted in the following changes from BL to week 12, respectively: the mean score of BDI decreased from 17.7 ± 10.7 to 10.0 ± 10.7 (p <0.0097), while the Behavioral Assessment score of the UHDRS decreased from 54.9 ± 11.3 to 32.5 ± 15.4 (p < 0.0001); ACE score increased from 75.1 ± 11.0 to 89.0 ± 9.3 (p < 0.0001); Cognitive Verbal Fluency score from 6.2 ± 2.5 to 7.7 ± 2.7 (p < 0.0103); Symbol Digit Test from 9.2 ± 6.9 to 12.3 ± 8.9 (p < 0.0009). Mild akathisia was the most frequent side effect, presenting in 2 out of 16 patients (12.5%). We conclude that CAR had a positive effect on depressive mood, apathy and cognitive functions in patients with early stage of HD. Based on the neurobiological basis of these symptoms, CAR can improve the dopamine imbalance of the prefrontal cortex. This draws attention to the transdiagnostic approach which supports the further understanding of the similar symptomatology of different neuropsychiatric disorders and helps to identify new indications of pharmaceutical compounds.

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Section: Discussionmentioning

confidence: 99%

Improving Mood and Cognitive Symptoms in Huntington's Disease With Cariprazine Treatment

Molnár

Fedor

et al. 2022

Front. Psychiatry

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“…Patients have severe social and occupational dysfunctions, difficulty attending to everyday tasks due to clinical symptoms (especially negative, affective and cognitive) or comorbid conditions, which have detrimental effects on their quality of life—yet, it remains a large unmet need ( 81 ). Furthermore, its evaluation is not standardized, as there is no consensus definition of psychosocial functioning ( 82 ). This was reflected in the presented cases as well: 10 patients reported reduced psychosocial functioning for which cariprazine treatment was initiated.…”

Section: Discussionmentioning

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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“…Both cariprazine doses were safe, well tolerated, and effective in decreasing depressive symptoms [349]. Although a singular dosage recommendation has not been standardized for cariprazine yet, the results of these studies indicate its efficacy in certain cases of BD [346][347][348][349].…”

Section: Cariprazinementioning

confidence: 94%

“…Some research data have indicated that both low and high doses of cariprazine are effective and well tolerated as a drug treatment for mania, depression, and psychosis [343][344][345]. RCTs of BD-I patients in manic and mixed episodes found the greatest treatment benefit when cariprazine was provided in the range of 3 to 12 mg [346,347]. Placebo-controlled studies of bipolar depression have indicated that 1.5 to 3 mg/d of cariprazine monotherapy is a competent treatment for acute depression in BD [346].…”

Section: Cariprazinementioning

confidence: 99%

Therapeutic Interventions to Mitigate Mitochondrial Dysfunction and Oxidative Stress–Induced Damage in Patients with Bipolar Disorder

Madireddy

2022

IJMS

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Bipolar disorder (BD) is characterized by mood changes, including recurrent manic, hypomanic, and depressive episodes, which may involve mixed symptoms. Despite the progress in neurobiological research, the pathophysiology of BD has not been extensively described to date. Progress in the understanding of the neurobiology driving BD could help facilitate the discovery of therapeutic targets and biomarkers for its early detection. Oxidative stress (OS), which damages biomolecules and causes mitochondrial and dopamine system dysfunctions, is a persistent finding in patients with BD. Inflammation and immune dysfunction might also play a role in BD pathophysiology. Specific nutrient supplements (nutraceuticals) may target neurobiological pathways suggested to be perturbed in BD, such as inflammation, mitochondrial dysfunction, and OS. Consequently, nutraceuticals may be used in the adjunctive treatment of BD. This paper summarizes the possible roles of OS, mitochondrial dysfunction, and immune system dysregulation in the onset of BD. It then discusses OS-mitigating strategies that may serve as therapeutic interventions for BD. It also analyzes the relationship between diet and BD as well as the use of nutritional interventions in the treatment of BD. In addition, it addresses the use of lithium therapy; novel antipsychotic agents, including clozapine, olanzapine, risperidone, cariprazine, and quetiapine; and anti-inflammatory agents to treat BD. Furthermore, it reviews the efficacy of the most used therapies for BD, such as cognitive–behavioral therapy, bright light therapy, imagery-focused cognitive therapy, and electroconvulsive therapy. A better understanding of the roles of OS, mitochondrial dysfunction, and inflammation in the pathogenesis of bipolar disorder, along with a stronger elucidation of the therapeutic functions of antioxidants, antipsychotics, anti-inflammatory agents, lithium therapy, and light therapies, may lead to improved strategies for the treatment and prevention of bipolar disorder.

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The efficacy of cariprazine on function in patients with bipolar depression: a post hoc analysis of a randomized controlled trial

Cited by 19 publications

References 49 publications

Improving Mood and Cognitive Symptoms in Huntington's Disease With Cariprazine Treatment

Improving Mood and Cognitive Symptoms in Huntington's Disease With Cariprazine Treatment

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

Therapeutic Interventions to Mitigate Mitochondrial Dysfunction and Oxidative Stress–Induced Damage in Patients with Bipolar Disorder

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