Adjunctive brexpiprazole for the treatment of major depressive disorder

ABSTRACT

Introduction: The lifetime prevalence of major depressive episodes in the United States is nearly 17%. Clinical trials and clinical effectiveness studies have demonstrated that many patients will fail to achieve remission using traditional monotherapy, contributing to significant morbidity and suffering. Because of this, augmentation strategies have been proposed to improve both treatment response and remission.

Areas covered: Brexpiprazole is a second generation antipsychotic (SGA) approved by the US FDA in 2015 as an add-on treatment to an antidepressant medication for the treatment of adults with MDD, based on the results of two large-scale, randomized, placebo-controlled trials. It is thought to exert its antidepressant effect by a partial agonism of both the dopamine D2 and serotonin 5HT1A receptors. In addition, it also has potent antagonistic activity at 5HT2A, α1B and α2 C receptors, which may also contribute to monoamine transmission regulation.

Expert Opinion: Overall, the tolerability of brexpiprazole is promising with relatively low rates of side effects and discontinuation rates, thus establishing it as a new option for the treatment of depression.

KEYWORDS:

• Depression
• antidepressant
• atypical antipsychotic
• augmentation treatment
• brexpiprazole

Declaration of interest

J Beyer has received research support from: Alcobra, Allergan, Daiachi, Forest and Genomind. R.H. Weisler has received research support from Alcobra, Roche-Genetech, Allergan, Shire, Daiichi Sankyo Pharma, Genomind, Theravance, Janssen, Merck, Neurim and Otsuka America Pharmaceuticals. He is a consultant for Alcobra, Rhodes Pharmaceuticals, AltheaDx, Inc, Shire, Sunovion, Supernus Pharmaceuticals, Ironshore Pharmaceuticals, Validus, Lundbeck, Neos Therapeutics, Nestlé Health Science-PamLab, Inc. and Otsuka America Pharmaceuticals. R.H. Weisler has been on the speaker’s bureau for Shire, Sunovion, Lundbeck, Nestlé Health Science-PamLab, Inc. and Otsuka America Pharmaceuticals. Additionally, he is both a consultant and evaluator for Major League Baseball (MLB) and the National Football League (NFL). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

Funding was received from Duke University Medical Center.