ГоловнаArchive of numbers2020Volume 28, issue 3 (104)Long-term cariprazine treatment for the prevention of relapse in patients with schizophrenia: A randomized, double-blind, placebo-controlled trial
Title of the article | Long-term cariprazine treatment for the prevention of relapse in patients with schizophrenia: A randomized, double-blind, placebo-controlled trial | ||||
Authors |
Durgam Suresh Earley Willie Li Rui Li Dayong Lu Kaifeng Laszlovszky István Fleischhacker W. Wolfgang Nasrallah Henry A. |
||||
In the section | ORIGINAL RESEARCHES | ||||
Year | 2020 | Issue | Volume 28, issue 3 (104) | Pages | 27-37 |
Type of article | Scientific article | Index UDK | 616.895.8--071-036.65-039.71 | Index BBK | - |
Abstract | DOI: https://doi.org/10.36927/2079-0325-V28-is3-2020-5 Cariprazine, a dopamine D3/D2 receptor partial agonist with preference for D3 receptors, has demonstrated efficacy in randomized controlled trials in schizophrenia. This multinational, randomized, double-blind, placebo-controlled, parallel-group study evaluated the efficacy, safety, and tolerability of cariprazine for relapse prevention in adults with schizophrenia; total study duration was up to 97 weeks. Schizophrenia symptoms were treated/stabilized with cariprazine 3—9 mg/d during 20-week open-label treatment consisting of an 8-week, flexible-dose run-in phase and a 12-week fixed-dose stabilization phase. Stable patients who completed open-label treatment could be randomized to continued cariprazine (3, 6, or 9 mg/d) or placebo for double-blind treatment (up to 72 weeks). The primary efficacy parameter was time to relapse (worsening of symptom scores, psychiatric hospitalization, aggressive/violent behavior, or suicidal risk); clinical measures were implemented to ensure safety in case of impending relapse. A total of 264/765 patients completed open-label treatment; 200 eligible patients were randomized to double-blind placebo (n = 99) or cariprazine (n = 101). Time to relapse was significantly longer in cariprazine — versus placebo-treated patients (P = .0010, log-rank test). Relapse occurred in 24.8% of cariprazine- and 47.5% of placebo-treated patients (hazard ratio [95% CI] = 0.45 [0.28, 0.73]). Akathisia (19.2%), insomnia (14.4%), and headache (12.0%) were reported in ≥ 10% of patients during open-label treatment; there were no cariprazine adverse events ≥ 10% during double-blind treatment. Long-term cariprazine treatment was significantly more effective than placebo for relapse prevention in patients with schizophrenia. The long-term safety profile in this study was consistent with the safety profile observed in previous cariprazine clinical trials. ClincalTrials.gov identifier: NCT01412060. |
||||
Key words | schizophrenia; cariprazine; long-term treatment; relapse prevention; randomized controlled trial; oral antipsychotics | ||||
Access to full text version of the article pdf | download | ||||
Bibliography | 1.
American Psychiatric Association, 2000. Diagnostic and Statistical Manual of Mental Disorders (fourth ed.), American Psychiatric Association, Washington, DC (Text Revision).
2. Arato, M., O’Connor, R., Meltzer, H. Y., Z. S. Group, 2002. A 1-year, double-blind, placebo-controlled trial of ziprasidone 40, 80 and 160 mg/day in chronic schizophrenia: the Ziprasidone Extended Use in Schizophrenia (ZEUS) study // Int. Clin. Psychopharmacol. 17 (5), 207–215. 3. Axelrod, B. N., Goldman, R. S., Alphs, L. D., 1993. Validation of the 16-item Negative Symptom Assessment // J. Psychiatr. Res. 27 (3), 253–258. 4. Barnes, T. R., 1989. A rating scale for drug-induced akathisia. Br. J. Psychiatry. 154, 672–676. 5. Beasley Jr., C. M., Sutton, V. K., Hamilton, S. H., Walker, D. J., Dossenbach, M., Taylor, C. C., Alaka, K. J., Bykowski, D., Tollefson, G. D., 2003. Olanzapine Relapse Prevention Study, G. A double-blind, randomized, placebo-controlled trial of olanzapine in the prevention of psychotic relapse. J. Clin. Psychopharmacol. 23 (6), 582–594. 6. Durgam, S., Starace, A., Li, D., Migliore, R., Ruth, A., Németh, G., Laszlovszky, I., 2014. An evaluation of the safety and efficacy of cariprazine in patients with acute exacerbation of schizophrenia: a phase II, randomized clinical trial. Schizophr. Res. 152 (2–3), 450–457. 7. Durgam, S., Cutler, A. J., Lu, K., Migliore, R., Ruth, A., Laszlovszky, I., Németh, G., Meltzer, H. Y., 2015. Cariprazine in acute exacerbation of schizophrenia: a fixed-dose, phase III randomized, double-blind, placebo- and active-controlled trial. J. Clin. Psychiatry 76 (12), e1574–e1582. 8. Emsley, R., Chiliza, B., Asmal, L., Harvey, B. H., 2013. The nature of relapse in schizophrenia. BMC Psychiatry 13, 50. 9. Fleischhacker, W. W., Arango, C., Arteel, P., Barnes, T. R., Carpenter, W., Duckworth, K., Galderisi, S., Halpern, L., Knapp, M., Marder, S. R., Moller, M., Sartorius, N., Woodruff, P., 2014. Schizophrenia — time to commit to policy change. Schizophr. Bull. 40 (Suppl. 3), S165–S194. 10. Graff-Guerrero, A., Mamo, D., Shammi, C. M., Mizrahi, R., Marcon, H., Barsoum, P., Rusjan, P., Houle, S.,Wilson, A. A., Kapur, S., 2009. The effect of antipsychotics on the high-affinity state of D2 and D3 receptors: a positron emission tomography study With [11C]-(+)-PHNO. Arch. Gen. Psychiatry 66 (6), 606–615. 11. Guy, W., 1976a. The Abnormal Movement Scale. ECDEU Assessment Manual for Psychopharmacology. National Institute of Mental Health, Rockville, MD, pp. 218–222 (DHEW Publication No. 76-338). 12. Guy, W., 1976b. ECDEU Assessment Manual for Psychopharmacology. Revised. DHEW publication, no. (ADM) 76-338. US Dept of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, Psychopharmacology Research Branch, Division of Extramural Research Programs, Rockville, MD (1976. p. 218–22, 534–7). 13. Gyertyán, I., Sághy, K., Laszy, J., Elekes, O., Kedves, R., Gémesi, L. I., Pásztor, G., Zájer-Balázs, M., Kapás, M., Csongor, E. Á., Domány, G., Kiss, B., Szombathelyi, Z., 2008. Subnanomolar dopamine D3 receptor antagonism coupled to moderate D2 affinity results in favourable antipsychotic-like activity in rodent models: II. Behavioural characterisation of RG-15. Naunyn Schmiedeberg’s Arch. Pharmacol. 378 (5), 529–539. 14. Gyertyán, I., Kiss, B., Sághy, K., Laszy, J., Szabó, G., Szabados, T., Gemesi, L. I., Pásztor, G., Zájer-Balázs, M., Kapás, M., Csongor, E. Á., Domány, G., Tihanyi, K., Szombathelyi, Z., 2011. Cariprazine (RGH-188), a potent D3/D2 dopamine receptor partial agonist, binds to dopamine D3 receptors in vivo and shows antipsychotic-like and procognitive effects in rodents. Neurochem. Int. 59 (6), 925–935. 15. Kane, J. M., 2007. Treatment strategies to prevent relapse and encourage remission. J. Clin. Psychiatry 68 (Suppl. 14), 27–30. 16. Kane, J. M., Mackle, M., Snow-Adami, L., Zhao, J., Szegedi, A., Panagides, J., 2011. A randomized placebo-controlled trial of asenapine for the prevention of relapse of schizophrenia after long-term treatment. J. Clin. Psychiatry 72 (3), 349–355. 17. Kane, J. M., Zukin, S., Wang, Y., Lu, K., Ruth, A., Nagy, K., Laszlovszky, I., Durgam, S., 2015. Efficacy and safety of cariprazine in acute exacerbation of schizophrenia: results from an international, phase III clinical trial. J. Clin. Psychopharmacol. 35 (4), 1–7. 18. Kay, S. R., Fiszbein, A., Opler, L. A., 1987. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr. Bull. 13 (2), 261–276. 19. Kiss, B., Laszlovszky, I., Horváth, A., Némethy, Z., Schmidt, E., Bugovics, G., Fazekas, K., Gyertyán, I., Csongor, E. Á., Domány, G., Szombathelyi, Z., 2008. Subnanomolar dopamine D3 receptor antagonism coupled to moderate D2 affinity results in favourable antipsychotic-like activity in rodent models: I. Neurochemical characterisation of RG-15. Naunyn Schmiedeberg’s Arch. Pharmacol. 378 (5), 515–528. 20. Kiss, B., Horváth, A., Némethy, Z., Schmidt, E., Laszlovszky, I., Bugovics, G., Fazekas, K., Hornok, K., Orosz, S., Gyertyán, I., Csongor, E. Á., Domány, G., Tihanyi, K., Adham, N., Szombathelyi, Z., 2010. Cariprazine (RGH-188), a dopamine D(3) receptor-preferring, D(3)/D(2) dopamine receptor antagonist-partial agonist antipsychotic candidate: in vitro and neurochemical profile. J. Pharmacol. Exp. Ther. 333 (1), 328–340. 21. Laszy, J., Laszlovszky, I., Gyertyán, I., 2005. Dopamine D3 receptor antagonists improve the learning performance in memory-impaired rats. Psychopharmacology 179 (3), 567–575. 22. Lehman, A. F., Lieberman, J. A., Dixon, L. B., McGlashan, T. H., Miller, A. L., Perkins, D. O., Kreyenbuhl, J., American Psychiatric Association; Steering Committee on Practice Guidelines, 2004. Practice guideline for the treatment of patients with schizophrenia, second edition. Am. J. Psychiatry 161 (2 Suppl.), 1–56. 23. Leucht, S., Heres, S., 2006. Epidemiology, clinical consequences, and psychosocial treatment of nonadherence in schizophrenia. J. Clin. Psychiatry 67 (Suppl. 5), 3–8. 24. Leucht, S., Tardy, M., Komossa, K., Heres, S., Kissling, W., Salanti, G., Davis, J. M., 2012. Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis. Lancet 379 (9831), 2063–2071. 25. Mizrahi, R., Agid, O., Borlido, C., Suridjan, I., Rusjan, P., Houle, S., Remington, G., Wilson, A. A., Kapur, S., 2011. Effects of antipsychotics on D3 receptors: a clinical PET study in first episode antipsychotic naive patients with schizophrenia using [11C]-(+)- PHNO. Schizophr. Res. 131 (1–3), 63–68. 26. Morken, G., Widen, J. H., Grawe, R. W., 2008. Non-adherence to antipsychotic medication, relapse and rehospitalisation in recent-onset schizophrenia. BMC Psychiatry 8, 32. 27. Morosini, P. L., Magliano, L., Brambilla, L., Ugolini, S., Pioli, R., 2000. Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatr. Scand. 101 (4), 323–329. 28. Nakamura, T., Kubota, T., Iwakaji, A., Imada, M., Kapás, M., Morio, Y., 2016. Clinical pharmacology study of cariprazine (MP‑214) in patients with schizophrenia (12-week treatment). Drug Des. Dev. Ther. 10, 327–338. 29. Olivares, J. M., Sermon, J., Hemels, M., Schreiner, A., 2013. Definitions and drivers of relapse in patients with schizophrenia: a systematic literature review. Ann. General Psychiatry 12 (1), 32. 30. Pigott, T. A., Carson, W. H., Saha, A. R., Torbeyns, A. F., Stock, E. G., Ingenito, G. G., Aripiprazole Study, G., 2003. Aripiprazole for the prevention of relapse in stabilized patients with chronic schizophrenia: a placebo-controlled 26-week study. J. Clin. Psychiatry 64 (9), 1048–1056. 31. Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., Currier, G. W., Melvin, G. A., Greenhill, L., Shen, S., Mann, J. J., 2011. The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am. J. Psychiatry 168 (12), 1266–1277. 32. Schwartz, J. C., Diaz, J., Pilon, C., Sokoloff, P., 2000. Possible implications of the dopamine D(3) receptor in schizophrenia and in antipsychotic drug actions. Brain Res. Brain Res. Rev. 31 (2–3), 277–287. 33. Simpson, G. M., Angus, J. W., 1970. A rating scale for extrapyramidal side effects. Acta Psychiatr. Scand. Suppl. 212, 11–19. 34. Taylor, D., 2009. Psychopharmacology and adverse effects of antipsychotic long-acting injections: a review. Br. J. Psychiatry Suppl. 52, S13–S19. 35. Taylor, M., Chaudhry, I., Cross, M., McDonald, E., Miller, P., Pilowsky, L., Strickland, P., Relapse Prevention in Schizophrenia Consensus, G., 2005. Towards consensus in the long-term management of relapse prevention in schizophrenia. Hum. Psychopharmacol. 20 (3), 175–181. 36. Whiteford, H. A., Degenhardt, L., Rehm, J., Baxter, A. J., Ferrari, A. J., Erskine, H. E., Charlson, F. J., Norman, R. E., Flaxman, A. D., Johns, N., Burstein, R., Murray, C. J., Vos, T., 2013. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet 382 (9904), 1575–1586. |