Treating schizophrenia with cariprazine: from clinical research to clinical practice. Real world experiences and recommendations from an International Panel.

BACKGROUND

Management of schizophrenia is sub-optimal in many patients. Targeting negative symptoms, among the most debilitating aspects of schizophrenia, together with positive symptoms, can result in significant functional benefits and dramatically improve quality of life for patients and their carers. Cariprazine, a partial agonist of the dopamine receptors D2/D3 has demonstrated effectiveness across symptom domains in clinical trials, particularly on negative symptoms.

OBJECTIVE

To obtain a broader insight from clinicians with specific experience with cariprazine, on how it affects patient populations outside the clinical trial setting.

METHODS

The panel addressed a series of psychopharmacologic topics not comprehensively addressed by the evidence-based literature, including characteristics of patients treated, dosing and switching strategies, duration of therapy, role of concomitant medications and tolerability as well as recommendations on how to individualize cariprazine treatment for patients with schizophrenia.

RESULTS

Patients recommended for cariprazine treatment are those with first episodes of psychosis, predominant negative symptoms (maintenance/acute phase) and significant side effects (metabolic side effects, hyperprolactinemia, sedation) with other antipsychotics. When the long-term treatment of a lifetime illness is adequately weighted, cariprazine becomes one of the first-line medications, not only for patients with predominant negative symptoms but also for those with relatively severe positive symptoms, especially if they are at the first episodes and if a specific medication is added for symptoms such as agitation or insomnia. For instance, patients with agitation may also benefit from the combination of cariprazine and a benzodiazepine or another sedating agent. Cariprazine may be prescribed as add-on to medications such as clozapine, when that medication alone is ineffective for negative symptoms, and sometimes the first may be discontinued or its dose lowered, after a period of stability, leaving the patient on a better tolerated antipsychotic regimen.

CONCLUSIONS

Based on real-world clinical experience, the panel considered that cariprazine, with its distinct advantages including pharmacokinetics/pharmacodynamics, good efficacy and tolerability, represents a drug of choice in the long-term management of schizophrenia not only for patients with predominant negative symptoms but also for those with positive symptoms.

Informations de copyright

© The Author(s) 2020.

Déclaration de conflit d'intérêts

Competing interestsAF is/has been a consultant and/or a speaker and/or has received research grants from Allergan, Angelini, Apsen, Boheringer Ingelheim, Daiichi Sankyo Brasil Farmacêutica, Doc Generici, FB-Health, Italfarmaco, Janssen, Lundbeck, Mylan, Otsuka, Pfizer, Recordati, Sanofi Aventis, Sunovion, Vifor; JAA has been a speaker for Adamed, Angelini, Casen Recordati, Lundbeck, Janssen-Cilag, Pfizer and Servier and an advisor to Lundbeck, Janssen-Cilag and Servier; TA has given lectures and participated in Advisory Boards for Janssen-Cilag, Otsuka, Recordati, Servier, Lilly; WB has reported no conflicts of interest; MNKB has been a consultant and speaker for Lundbeck, Otsuka and Recordati; JG has been an occasional speaker for Lundbeck, Janssen, Jaba-Recordati, Angelini; GC has been a speaker for Recordati, Janssen Cilag, Lundbeck, Doc Generici; MC TBA; FCS has received honoraria from the following companies for presentations fees and travel grants from Casen Recordati, Lundbeck-Otsuka, Janssen; AC is/has been a consultant and/or a speaker for Angelini, Apsen, Lundbeck, Otsuka, Pfizer; HF has received speaker and consultant honoraria (last 3 years) from Recordati, Servier, Janssen-Cilag; EI has acted as a consultant for Recordati; P-A K has given lectures for Eli Lilly, Janssen, Recordati, Lundbeck, Astra Zeneca, was involved in conducting safety studies for Janssen, Eli Lilly and took part in Advisory boards for Recordati and Eli Lilly; PP has been a speaker and/or consultant and/or received grants from Astra Zeneca, Janssen, Lundbeck, Recordati, Sunovion, Servier; MP has reported no conflicts of interest; HJRP has reported no conflicts of interest; JSS has given talks for Recordati and his employer Sahlgrenska University Hospital Gothenburg; IBV has given lectures for Recordati, Janssen, Neuraxpharm and Otsuka.