Cariprazine — an Alternative Treatment for Clozapine-resistant Schizophrenia?
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Treatment-resistant schizophrenia (TRS) poses a significant therapeutic challenge in psychiatric practice. Clozapine is recognized as a treatment of choice in TRS but is not always effective in alleviating patients’ symptoms. Additionally, clozapine therapy is associated with multiple side effects and monitoring requirements that often limit its use and negatively affect patients’ compliance with the treatment. Although clozapine augmentation options are available, there is currently no alternative monotherapy proven to be effective in TRS. We present a case of a young man with TRS who failed to respond to appropriate trials of risperidone, aripiprazole and also clozapine, and who experienced impairing adverse effects of clozapine that made further clozapine treatment not only futile but also detrimental to his health. He was successfully treated with cariprazine monotherapy, which culminated in the remission of his both positive and negative symptoms of psychosis as well as in the marked improvement in social functioning. Cariprazine, a newer atypical antipsychotic endowed with a D3-preferring mode of action, may offer a better tolerated and more acceptable treatment option for patients with difficult-to-treat psychotic symptoms.
Abstract
Treatment-resistant schizophrenia (TRS) poses a significant therapeutic challenge in psychiatric practice. Clozapine is recognized as a treatment of choice in TRS but is not always effective in alleviating patients’ symptoms. Additionally, clozapine therapy is associated with multiple side effects and monitoring requirements that often limit its use and negatively affect patients’ compliance with the treatment. Although clozapine augmentation options are available, there is currently no alternative monotherapy proven to be effective in TRS. We present a case of a young man with TRS who failed to respond to appropriate trials of risperidone, aripiprazole and also clozapine, and who experienced impairing adverse effects of clozapine that made further clozapine treatment not only futile but also detrimental to his health. He was successfully treated with cariprazine monotherapy, which culminated in the remission of his both positive and negative symptoms of psychosis as well as in the marked improvement in social functioning. Cariprazine, a newer atypical antipsychotic endowed with a D3-preferring mode of action, may offer a better tolerated and more acceptable treatment option for patients with difficult-to-treat psychotic symptoms.
참고문헌 (24)
- Siskind D, "Clozapine response rates among people with treatment-resistant schizophrenia : data from a systematic review and meta-analysis", Can J Psychiatry, 62, pp.772~777 (2017)
- Nucifora FC Jr, "Treatment resistant schizophrenia : clinical, biological, and therapeutic perspectives", Neurobiol Dis, 131, pp.104257~ (2019)
- Kane J, "Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine", Arch Gen Psychiatry, 45, pp.789~796 (1988)
- Farooq S, "Barriers to using clozapine in treatment-resistant schizophrenia : systematic review", BJPsych Bull, 43, pp.8~16 (2019)
- Pillinger T, "Comparative effects of 18 antipsychotics on metabolic function in patients with schizophrenia, predictors of metabolic dysregulation, and association with psychopathology : a systematic review and network meta-analysis", Lancet Psychiatry, 7, pp.64~77 (2020)
- Frankel JS, "Brexpiprazole and cariprazine : distinguishing two new atypical antipsychotics from the original dopamine stabilizer aripiprazole", Ther Adv Psychopharmacol, 7, pp.29~41 (2017)
- Garnock-Jones KP, "Cariprazine : a review in schizophrenia", CNS Drugs, 31, pp.513~525 (2017)
- Durgam S, "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, pp.450~457 (2014)
- Durgam S, "Cariprazine in acute exacerbation of schizophrenia : a fixed-dose, phase 3, randomized, double-blind, placebo-and active-controlled trial", J Clin Psychiatry, 76, pp.e1574~e1582 (2015)
- Kane JM, "Efficacy and safety of cariprazine in acute exacerbation of schizophrenia : results from an international, phase III clinical trial", J Clin Psychopharmacol, 35, pp.367~373 (2015)
- Laszlovszky I, "Cariprazine, a broadspectrum antipsychotic for the treatment of schizophrenia : pharmacology, efficacy, and safety", Adv Ther, 38, pp.3652~3673 (2021)
- Domenico De Berardis, "Cariprazine Add-on in Inadequate Clozapine Response: A Report on Two Cases", Clinical Psychopharmacology and Neuroscience, 19(1), pp.174~178 (2021), 대한정신약물학회[DOI]
- Németh G, "Cariprazine versus risperidone monotherapy for treatment of predominant negative symptoms in patients with schizophrenia : a randomised, double-blind, controlled trial", Lancet, 389, pp.1103~1113 (2017)
- Judith Weise, "Add-on Cariprazine in Patients with Long-term Clozapine Treatment and Treatment Resistant Schizophrenia: Two Cases of Psychotic Deterioration and Pisa Syndrome", Clinical Psychopharmacology and Neuroscience, 20(2), pp.398~401 (2022), 대한정신약물학회[DOI]
- Levine SZ, "Identifying clinically meaningful symptom response cut-off values on the SANS in predominant negative symptoms", Schizophr Res, 145, pp.125~127 (2013)
- Wagner E, "Clozapine augmentation strategies-a systematic meta-review of available evidence. Treatment options for clozapine resistance", J Psychopharmacol, 33, pp.423~435 (2019)
- Ceskova E, "Novel treatment options in depression and psychosis", Neuropsychiatr Dis Treat, 14, pp.741~747 (2018)
- De Berardis D, "The novel antipsychotic cariprazine(RGH-188) : state-of-the-art in the treatment of psychiatric disorders", Curr Pharm Des, 22, pp.5144~5162 (2016)
- Fagiolini A, "Treating schizophrenia with cariprazine : from clinical research to clinical practice. Real world experiences and recommendations from an International Panel", Ann Gen Psychiatry, 19, pp.55~ (2020)
- Vasiliu O, "Case report : cariprazine efficacy in young patients diagnosed with schizophrenia with predominantly negative symptoms", Front Psychiatry, 12, pp.786171~ (2021)
- Rancans E, "The effectiveness and safety of cariprazine in schizophrenia patients with negative symptoms and insufficient effectiveness of previous antipsychotic therapy : an observational study", Int Clin Psychopharmacol, 36, pp.154~161 (2021)
- Meltzer HY, "An overview of the mechanism of action of clozapine", J Clin Psychiatry, 55(Suppl B), pp.47~52 (1994)
- Ucok A, "Reasons for clozapine discontinuation in patients with treatment-resistant schizophrenia", Psychiatry Res, 275, pp.149~154 (2019)
- Newman-Tancredi A, "Comparative pharmacology of antipsychotics possessing combined dopamine D2 and serotonin 5-HT1A receptor properties", Psychopharmacology(Berl), 216, pp.451~473 (2011)