Cariprazine - a novel antipsychotic drug and its place in the treatment of schizophrenia.

Błażej Misiak,Przemysław Bieńkowski,Jerzy Samochowiec

doi:10.12740/pp/onlinefirst/80710

Błażej Misiak, Przemysław Bieńkowski + Show 1 more

Open Access

https://doi.org/10.12740/pp/onlinefirst/80710

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Abstract

Although the development of second-generation antipsychotics was a cornerstone in the treatment of schizophrenia, several unmet treatment needs in the field still exist. It is particularly important to note that available antipsychotics have limited efficacy in the treatment of negative symptoms and cognitive impairment. At this point, it should be noted that primary negative symptoms, i.e., those that are not due to depression, extrapyramidal symptoms or psychotic withdrawal, might affect even one-fourth of patients with schizophrenia and are associated with poor clinical and functional outcomes. Cariprazine, is an emerging antipsychotic drug, D3/D2 receptor partial agonist, with affinity to several serotonin receptors. In this article, we provide an overview of pharmacokinetic and pharmacodynamic properties of cariprazine, showing its unique receptor profile. Next, we discuss results of double-blind, placebo-controlled, randomized clinical trials and post hoc analyses of cariprazine that have been published to date. These studies have provided evidence for efficacy of cariprazine in the treatment of schizophrenia exacerbations compared to placebo, with safety and good tolerability. In addition, one clinical trial published to date revealed superior efficacy of cariprazine compared to risperidone in the treatment of predominant negative symptoms that had been also associated with concomitant improvement of functional performance. Overall, current evidence in the field supports the use of cariprazine in exacerbation of schizophrenia and suggests promising efficacy in the treatment of predominant negative symptoms.

Highlights

Schizophrenia is a severe mental illness with multiple psychopathological symptoms, including positive, negative and affective symptoms as well as cognitive impairment
We provide an overview of cariprazine as an emerging antipsychotic drug with particular attention on its promising role in the treatment of negative symptoms
Convincing evidence from clinical trials supports the efficacy of cariprazine in the treatment of schizophrenia exacerbations

Summary

Introduction

Schizophrenia is a severe mental illness with multiple psychopathological symptoms, including positive, negative and affective symptoms as well as cognitive impairment. Patients who develop primary negative symptoms, i.e., those that are not secondary to depression, drug-induced extrapyramidal symptoms or psychotic withdrawal, represent a relatively homogeneous group in terms of clinical characteristics and outcomes. This subgroup of patients comprises approximately 15–25% of all schizophrenia patients [3]. Patients with primary negative symptoms, especially those with deficit schizophrenia subtype, present several unfavorable clinical characteristics, including poorer premorbid adjustment with insidious onset of psychosis, higher levels of neurological soft signs, more robust cognitive impairments, a number of electrophysiological disturbances, more pronounced structural brain abnormalities, worse psychosocial functioning and poorer long-term outcomes (for review see [7]). We provide an overview of cariprazine as an emerging antipsychotic drug with particular attention on its promising role in the treatment of negative symptoms

Antagonist Antagonist Antagonist Antagonist

Randomized clinical trials

Post hoc analyses

Findings

Summary of evidence and future directions