brexpiprazole and Sleep-Initiation-and-Maintenance-Disorders

A post hoc analysis was performed using data obtained over eight weeks from 200 Japanese patients with schizophrenia who were switched to brexpiprazole monotherapy in a long-term treatment study. The 8-week period comprised of a 4-week switching phase and a 4-week post-switch phase. For the antipsychotic switching schedule, brexpiprazole was first administered at 1 mg/day and increased to 2 mg/day by the end of week 4. Concurrently, the previous antipsychotic(s) was/were tapered gradually from the start of week 3 and discontinued by the end of week 4. Brexpiprazole could then be increased up to 4 mg/day according to the CGI-I criteria. At week 8, 1.8%, 23.2%, 25.0%, and 50% of patients were administered daily brexpiprazole doses of 1, 2, 3, and 4 mg, respectively. The discontinuation rate at week 8 was 17.0%. The major reasons for discontinuation were consent withdrawal (9.5%), occurrence of adverse events (5.5%), and physician's decision (2.0%). Commonly reported adverse events were nasopharyngitis (13.5%), schizophrenia (9.0%), insomnia (6.5%), headache (5.5%), and akathisia (5.5%). The discontinuation rate was 4.9% for patients who were switched from aripiprazole as the primary antipsychotic and 25.4% for those who were switched from other antipsychotics. Owing to the serious adverse events that led to treatment discontinuation, careful switching to brexpiprazole is necessary in patients who previously used olanzapine as their primary antipsychotic.

Topics: Adolescent; Adult; Aged; Antipsychotic Agents; Dopamine Agonists; Dose-Response Relationship, Drug; Double-Blind Method; Drug Substitution; Female; Headache; Humans; Japan; Longitudinal Studies; Male; Middle Aged; Quinolones; Schizophrenia; Schizophrenic Psychology; Sleep Initiation and Maintenance Disorders; Thiophenes; Treatment Outcome; Young Adult

Although the sedative and extrapyramidal side effects associated with first-generation antipsychotics are well known, some second-generation antipsychotics are also associated with substantial sedation and activation effects. In this Academic Highlights article, 4 experts on depression from the fields of psychiatry and primary care take a closer look at activation and sedation effects of atypical antipsychotics in patients with MDD. They examine the likelihood of each agent to cause these effects; the impact of these effects on patient functioning, quality of life, and treatment adherence; and the question of whether leveraging activation and sedation to address acute symptoms is ever advisable.

Topics: Adult; Antidepressive Agents; Antipsychotic Agents; Anxiety Disorders; Aripiprazole; Arousal; Comorbidity; Delayed-Action Preparations; Depressive Disorder, Major; Drug Approval; Drug Therapy, Combination; Female; Humans; Hypnotics and Sedatives; Male; Middle Aged; Practice Patterns, Physicians'; Quality of Life; Quetiapine Fumarate; Quinolones; Sleep Initiation and Maintenance Disorders; Thiophenes