Sofia Pappa, Arturas Kalniunas, Hitendra Sharma, Ali Raza-Syed, Manzar Kamal, Fintan Larkin
{"title":"Efficacy and safety of cariprazine augmentation in patients treated with clozapine: a pilot study.","authors":"Sofia Pappa, Arturas Kalniunas, Hitendra Sharma, Ali Raza-Syed, Manzar Kamal, Fintan Larkin","doi":"10.1177/20451253221132087","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Cariprazine, a novel antipsychotic drug, is a partial agonist of dopamine D2/D3 receptors with preferential binding to the D3 receptor. There has been an increasing interest in cariprazine augmentation to clozapine; however, the evidence thus far has been only limited to case reports and case series.</p><p><strong>Objectives: </strong>To evaluate the efficacy and safety of the augmentation of clozapine with cariprazine in patients with sub-optimal treatment response.</p><p><strong>Methods: </strong>Demographic and clinical information of the study population were collected from the electronic records and PANSS scale administered at baseline and 3 months. Tolerability and discontinuation reasons where applicable were also recorded.</p><p><strong>Results: </strong>Ten patients (four men and six women) with a mean age of 36.5 years (range = 26-45) were included. Reasons for cariprazine initiation included inadequate treatment response, persistent negative symptoms and/or tolerability issues with clozapine or previous augmentation options. Two patients discontinued cariprazine within the first 6 weeks due to restlessness and poor response, respectively. There was a significant reduction in the median total PANSS score from baseline to 3 months (from 59 to 22.5, <i>p</i> < 0.05), median positive PANSS score (from 11.5 to 5.5, <i>p</i> < 0.05) and in the median negative PANSS score (from 15.5 to 3, <i>p</i> < 0.05) which correspond to a 48%, 33.8% and 65.8% mean score reduction, respectively.</p><p><strong>Conclusion: </strong>This is the first pilot study evaluating the effectiveness of clozapine augmentation. The preliminary evidence suggests that this may be a safe and effective practice in patients failing to adequately respond to or tolerate clozapine and/or previous augmentation strategies.</p>","PeriodicalId":23127,"journal":{"name":"Therapeutic Advances in Psychopharmacology","volume":null,"pages":null},"PeriodicalIF":3.4000,"publicationDate":"2022-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/96/6b/10.1177_20451253221132087.PMC9685211.pdf","citationCount":"3","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Therapeutic Advances in Psychopharmacology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/20451253221132087","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
引用次数: 3
Abstract
Background: Cariprazine, a novel antipsychotic drug, is a partial agonist of dopamine D2/D3 receptors with preferential binding to the D3 receptor. There has been an increasing interest in cariprazine augmentation to clozapine; however, the evidence thus far has been only limited to case reports and case series.
Objectives: To evaluate the efficacy and safety of the augmentation of clozapine with cariprazine in patients with sub-optimal treatment response.
Methods: Demographic and clinical information of the study population were collected from the electronic records and PANSS scale administered at baseline and 3 months. Tolerability and discontinuation reasons where applicable were also recorded.
Results: Ten patients (four men and six women) with a mean age of 36.5 years (range = 26-45) were included. Reasons for cariprazine initiation included inadequate treatment response, persistent negative symptoms and/or tolerability issues with clozapine or previous augmentation options. Two patients discontinued cariprazine within the first 6 weeks due to restlessness and poor response, respectively. There was a significant reduction in the median total PANSS score from baseline to 3 months (from 59 to 22.5, p < 0.05), median positive PANSS score (from 11.5 to 5.5, p < 0.05) and in the median negative PANSS score (from 15.5 to 3, p < 0.05) which correspond to a 48%, 33.8% and 65.8% mean score reduction, respectively.
Conclusion: This is the first pilot study evaluating the effectiveness of clozapine augmentation. The preliminary evidence suggests that this may be a safe and effective practice in patients failing to adequately respond to or tolerate clozapine and/or previous augmentation strategies.
背景:Cariprazine是一种新型抗精神病药物,是多巴胺D2/D3受体的部分激动剂,与D3受体优先结合。人们对氯氮平增加卡吡嗪的兴趣越来越大;然而,迄今为止的证据仅限于病例报告和病例系列。目的:评价氯氮平加卡吡嗪对治疗反应次优患者的疗效和安全性。方法:通过电子病历和基线及3个月时的PANSS量表收集研究人群的人口学和临床信息。在适用的情况下,还记录了耐受性和停产原因。结果:纳入10例患者(4男6女),平均年龄36.5岁(范围26-45岁)。开始使用卡吡嗪的原因包括治疗反应不足、持续的阴性症状和/或氯氮平或先前增强方案的耐受性问题。2例患者分别因躁动和不良反应在前6周内停用卡吡嗪。从基线到3个月,PANSS总评分中位数显著降低(从59降至22.5,p p p p)。结论:这是第一个评估氯氮平增强有效性的试点研究。初步证据表明,对于对氯氮平和/或先前的强化策略没有充分反应或耐受的患者,这可能是一种安全有效的做法。
期刊介绍:
Therapeutic Advances in Psychopharmacology delivers the highest quality peer-reviewed articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of psychopharmacology. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in psychopharmacology, providing a forum in print and online for publishing the highest quality articles in this area.