Brexpiprazole for the Treatment of Schizophrenia in Adults: An Overview of Its Clinical Efficacy and Safety and a Psychiatrist’s Perspective

Abstract

While the prognosis of patients with schizophrenia has dramatically improved after the advent of chlorpromazine, the antipsychotics currently available are so numerous that it has become a challenge for psychiatrists to choose from among these drugs for each patient presenting for care. In addition, while numerous studies show that an effective antipsychotic should be continued indefinitely to prevent relapses or worsening, many patients appear to have difficulty remaining on any drug thus initiated. Brexpiprazole, a dopamine D₂ receptor partial agonist, appears to provide a unique profile that has much to offer in this light. Specifically, this novel drug is potentially better suited for long-term use, with decreased risk of extrapyramidal side effects, hyperprolactinemia, weight gain, psychosis, insomnia, akathisia, nausea/vomiting or restlessness, thus potentially facilitating patients’ reintegration into society. Indeed, brexpiprazole has been shown in randomized, double-blind, placebo-controlled trials to have proven efficacy not only in improving the symptoms of schizophrenia but in preventing relapses. It is also suggested in both short- and long-term studies that brexpiprazole offers a favorable safety and tolerability profile. This review also includes a proposed treatment algorithm incorporating brexpiprazole, based on the clinical trial results available, as well as on the authors’ clinical experience, where brexpiprazole may be best used as a drug of first choice for the treatment of schizophrenia. Thus, overall, brexpiprazole appears to play a more significant role in the treatment of schizophrenia than other antipsychotics.

Keywords:

• brexpiprazole
• dopamine D₂ receptor partial agonist
• efficacy
• safety
• schizophrenia
• treatment algorithm

Acknowledgments

The authors thank Mr. H. Itoh, Interface, for his writing and editorial assistance with the manuscript.

Disclosure

YW has received speaker’s honoraria from Pfizer Japan Inc., Otsuka Pharmaceutical Co., Ltd., Janssen Pharmaceutical K.K., Meiji Seika Pharma Co., Ltd, Eli Lilly Japan K.K., MSD K.K. a subsidiary of Merck & Co., Inc., Takeda Pharmaceutical Co., Ltd., Mochida Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Corp., and Sumitomo Dainippon Pharma Co., Ltd. SY is an employee of Otsuka Pharmaceutical Co., Ltd. TO has received lecture fees from Eli Lily, Pfizer, Takeda Pharmaceutical, Otsuka Pharmaceutical, and Sumitomo Dainippon Pharma, Yoshitomi Yakuhin, Mochida, Meiji Seika Pharma, and Kyowa Pharmaceutical, and research/grant support from Eisai, and Otsuka Pharmaceutical. TK has received speaker’s honoraria from Astellas, Dainippon Sumitomo, Eli Lilly, Janssen, Otsuka, Takeda, Yoshitomi Yakuhin, and Pfizer. The authors report no other conflicts of interest in this work.