Brexpiprazole switch tied to low risk of metabolic abnormalities, adverse events

For patients with schizophrenia, a switch to brexpiprazole appears to be safe, carrying low long-term risk of metabolic abnormalities, hyperprolactinemia, extrapyramidal symptoms, and QT interval (QTc) prolongation, with minimal changes in psychiatric symptoms, according to a study.

The current analysis covered the entire 56 weeks of a trial involving 186 Japanese outpatients with schizophrenia, who switched to brexpiprazole 2 mg daily over a 4‐week period and continued with the same medication during a 52‐week, open‐label period. These patients were grouped into two, based on the type of atypical antipsychotic they previously used: a dopamine partial agonist (aripiprazole) or a dopamine antagonist (non‐aripiprazole), which included olanzapine, quetiapine, risperidone, paliperidone, blonanserin, and perospirone.

Major safety assessment items included cholesterol (total, low‐density lipoprotein [LDL], high‐density lipoprotein [HDL]), triglycerides, blood glucose, body weight, and prolactin. Secondary evaluations were related to efficacy, treatment emergent adverse events (TEAEs), extrapyramidal symptoms, and corrected QTc.

Over 56 weeks, 84 (45.2 percent) discontinued treatment, including 27 in the aripiprazole and 57 in the non-aripiprazole group. The most common reasons were withdrawal of consent and adverse events.

Patients in both treatment groups showed minimal changes in total, LDL, and HDL cholesterol, triglycerides, and glucose levels. They also had a slight increase in body weight (aripiprazole, 1.1 kg; non-aripiprazole, 0.4 kg).

Prolactin levels slightly rose in the aripiprazole group but dropped in the non-aripiprazole group. Symptom severity scores decreased by a similar magnitude in both.

TEAEs occurred in 161 (86.6 percent) patients overall (aripiprazole, 84.1 percent; non-aripiprazole, 88.5 percent). There were few changes noted in extrapyramidal symptom scales or QTc.

The present data suggest that brexpiprazole may be considered as a treatment option in case of safety or tolerability issues, especially those related to metabolic abnormalities or hyperprolactinemia, with current antipsychotic therapy.