Treating schizophrenia with cariprazine : from clinical research to clinical practice. Real world experiences and recommendations from an International Panel
Fagiolini, Andrea (University of Siena. School of Medicine, Department of Molecular Medicine)
Alcalá, José Ángel (Hospital Universitario Reina Sofía (Còrdova, Espanya))
Aubel, Thomas (Kliniken Essen-Mitte, Klinik für Psychiatrie, Psychotherapie, Psychosomatik und Suchtmedizin)
Bienkiewicz, Wojciech (GGZ Keizersgracht Outpatient Mental Health Clinic, Amsterdam, The Netherlands)
Bogren, Mats Magnus Knut (Divsion of Psychiatry, Department of Clinical Sciences, Lund University Hospital)
Gago, Joaquim (Nova Medical School. Mental Health Department)
Cerveri, Giancarlo (Department of Mental Health and Addiction, ASST Lodi, Lodi, Italy)
Colla, Michael (University of Rostock. Clinic and Polyclinic for Psychiatry and Psychotherapy)
Sanchez, Francisco Collazos (Universitat Autònoma de Barcelona. Departament de Psiquiatria i de Medicina Legal)
Cuomo, Alessandro (University of Siena. School of Medicine, Department of Molecular Medicine)
Helge, Frieling (Hannover Medical School. Department of Psychiatry, Social Psychiatry and Psychotherapy)
Iacoponi, Eduardo (King's College London. Institute of Psychiatry, Psychology & Neuroscience)
Karlsson, Per-Axel (Forensic Services of Norrbotten County Council, Öjebyn, Sweden)
Peddu, Pradeep (Psychosis Pathway Coventry and Warwickshire Partnership NHS Trust and Buckingham Medical School, Rugby, UK)
Pettorruso, Mauro (Department of Neuroscience, Imaging and Clinical Sciences, D'Annunzio University of Chieti, Pescara, Italy)
Pereira, Henrique Jorge Ramos (Hospital de Magalhães Lemos)
Schölin, Johan Sahlsten (Sahlgrenska University Hospital (Suècia))
Vernaleken, Ingo Bernd (RWTH Aachen University. Department of Psychiatry and Psychotherapy)

Date:	2020
Abstract:	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. To obtain a broader insight from clinicians with specific experience with cariprazine, on how it affects patient populations outside the clinical trial setting. 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. 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. 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.
Note:	Altres ajuts: Supported by an unrestricted grant from Recordati.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Schizophrenia ; Antipsychotics ; Cariprazine ; Patient subgroups ; Recommendations ; Negative symptoms
Published in:	Annals of General Psychiatry, Vol. 19 (september 2020) , ISSN 1744-859X

DOI: 10.1186/s12991-020-00305-3
PMID: 32999683

11 p, 1.1 MB

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