Treating schizophrenia with cariprazine : From clinical research to clinical practice. Real world experiences and recommendations from an International Panel
(2020) In Annals of General Psychiatry 19(1).- Abstract
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... (More)
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.
(Less)
- author
- publishing date
- 2020-09-26
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Antipsychotics, Cariprazine, Negative symptoms, Patient subgroups, Recommendations, Schizophrenia
- in
- Annals of General Psychiatry
- volume
- 19
- issue
- 1
- article number
- 55
- publisher
- BioMed Central (BMC)
- external identifiers
-
- scopus:85092268666
- pmid:32999683
- ISSN
- 1744-859X
- DOI
- 10.1186/s12991-020-00305-3
- language
- English
- LU publication?
- no
- id
- fe37c2c9-b066-4401-8056-c39b60ed2621
- date added to LUP
- 2020-10-27 14:28:07
- date last changed
- 2024-06-12 22:21:53
@article{fe37c2c9-b066-4401-8056-c39b60ed2621,
abstract = {{<p>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.</p>}},
author = {{Fagiolini, Andrea and Alcalá, José Ángel and Aubel, Thomas and Bienkiewicz, Wojciech and Bogren, Mats Magnus Knut and Gago, Joaquim and Cerveri, Giancarlo and Colla, Michael and Sanchez, Francisco Collazos and Cuomo, Alessandro and Helge, Frieling and Iacoponi, Eduardo and Karlsson, Per Axel and Peddu, Pradeep and Pettorruso, Mauro and Pereira, Henrique Jorge Ramos and Schölin, Johan Sahlsten and Vernaleken, Ingo Bernd}},
issn = {{1744-859X}},
keywords = {{Antipsychotics; Cariprazine; Negative symptoms; Patient subgroups; Recommendations; Schizophrenia}},
language = {{eng}},
month = {{09}},
number = {{1}},
publisher = {{BioMed Central (BMC)}},
series = {{Annals of General Psychiatry}},
title = {{Treating schizophrenia with cariprazine : From clinical research to clinical practice. Real world experiences and recommendations from an International Panel}},
url = {{http://dx.doi.org/10.1186/s12991-020-00305-3}},
doi = {{10.1186/s12991-020-00305-3}},
volume = {{19}},
year = {{2020}},
}