Skip to main navigation menu Skip to main content Skip to site footer

No. 3 (2024)

GENERAL THERAPY QUESTIONS AND REVIEWS

The Role of Cariprazine in the Prevention and Correction of Antipsychotic-Induced Cardiometabolic Disorders

Published 2024-09-30

  • A.V. Kidyaeva
    • ,
  • R.F. Nasyrova

A.V. Kidyaeva
V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology of the Ministry of Heath of the Russian Federation; St. Petersburg State Psychiatric Hospital of St. Nicholas

R.F. Nasyrova
V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology of the Ministry of Heath of the Russian Federation; St. Petersburg State Psychiatric Hospital of St. Nicholas; Tula State University

Abstract

Background. Metabolic syndrome is one of the most significant adverse drug reactions associated with the use of antipsychotics due to the high risk of developing cardiovascular diseases, including prolongation of the QT interval, which can lead to fatal ventricular arrhythmias and sudden cardiac death.

Objective — to analyze current data on the possibility of preventing and correcting cardiometabolic adverse effects in patients with mental disorders using the thirdgeneration antipsychotic drug cariprazine.

Methods. A search for full-text articles published from 25th July 2019 to 25th July 2024 was conducted in PubMed, eLibrary.ru, Google Scholar databases.

Results. In this review, the pharmacodynamic and pharmacokinetic characteristics of cariprazine, which determine its favorable cardiometabolic profile, are examined in detail. The results of studies on the effect of cariprazine on the components of the metabolic syndrome and changes in the QT interval in patients with mental disorders are analyzed and summarized. According to the results of the studies, cariprazine does not cause clinically significant changes in the lipid profile, glucose levels, body weight, and does not prolong the QT interval.

Conclusion. Cariprazine has a favorable cardiometabolic profile and can be used in patients with metabolic syndrome components and prolongation of the QT interval before or during antipsychotic therapy.

Keywords

cariprazine, metabolic syndrome, weight gain, QT prolongation, adverse drug reaction, mental disorder

PDF (Русский)

References

  1. Chesney E., Goodwin G.M., Fazel S. Risks of all-cause and suicide mortality in mental disorders: A meta-review // World Psychiatry. – 2014. – Vol. 2. – Рp. 153–160. – https://doi.org/10.1002/wps.20128
  2. Khasanova A. K. Pharmacogenetic factors of clozapine-induced metabolic syndrome // Personalized Psychiatry and Neurology. – 2023. – Vol. 3 (2). – Pp. 38–47. –https://doi.org/10.52667/2712-9179-2023-3-2-38-47
  3. Мосолов С.Н., Федорова Е.Ю. Риск развития сердечно-сосудистых заболеваний при биполярном расстройстве. Клинико-социальные факторы // Терапевтический архив. – 2021. – Т. 93, № 12. – С. 1556–1561. – https://doi.org/10.26442/00403660.2021.12.201175
  4. Pillinger T., McCutcheon R.A., Vano L. et al. 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 // The Lancet Psychiatry. – 2020. – Vol. 7 (1). – Pp. 64–77. – https://doi.org/10.1016/S2215-0366(19)30416-X
  5. Destere A., Merino D., Lavrut T. et al. Drug-induced cardiac toxicity and adverse drug reactions, a narrative review // Therapies. – 2023. – Vol. 79 (2). – Pp. 161–172. – https://doi.org/10.1016/j.therap.2023.10.008
  6. Lambiase P.D., de Bono J.P., Schilling R.J. et al. British heart rhythm society clinical practice guidelines on the management of patients developing QT prolongation on antipsychotic medication // Arrhythm Electrophysiol Rev. – 2019. – Vol. 8 (3). – Рp. 161–165. – https://doi.org/10.15420/aer.2019.8.3.G1
  7. Kaar S.J. Natesan S., McCutcheon R. et al. Antipsychotics: mechanisms underlying clinical response and side-effects and novel treatment approaches based on pathophysiology // Neuropharmacology. – 2020. – Vol. 172. – Art. 107704. – https://doi.org/10.1016/j.neuropharm.2019.107704
  8. Bernardo M., Rico-Villademoros F., García-Rizo C. et al. Real-world data on the adverse metabolic effects of second-generation antipsychotics and their potential determinants in adult patients: A systematic review of population-based studies // Advances in Therapy. – 2021. – Vol. 38. – Pp. 2491–2512. – https://doi.org/10.1007/s12325-021-01689-84
  9. Citrome L. Cariprazine for acute and maintenance treatment of adults with schizophrenia: An evidence-based review and place in therapy // Neuropsychiatric disease and treatment. – 2018. – Vol. 14. – Pp. 2563–2577. – https://doi.org/10.2147/NDT.S159704
  10. Государственный регистр лекарственных средств. – URL: https://grls.rosminzdrav.ru/ Grls_View_v2.aspx?routingGuid=888732b8-f07d-4c3c-ab9c-e4e9c65b119e (дата обращения 25.07.2024).
  11. Drugs@FDA: FDA-Approved Drugs. – Available at: https://www.accessdata.fda.gov/ scripts/cder/daf/index.cfm?event=overview.process&ApplNo=204370 (accessed July 25, 2024).
  12. Nasyrova R.F., Kidyaeva A.V., Shnayder N.A. Hematological Predictors of Antipsychoticinduced Metabolic Syndrome in a Female Patient with Schizophrenia: Case report // Personalized Psychiatry and Neurology. – 2024. – Vol. 4 (2). – Pp. 39–46. – https://doi.org/ 10.52667/2712-9179-2024-4-2-39-46
  13. Selvan P., Devkare P., Shetty A. et al. A review on the pharmacology of Cariprazine and its role in the treatment of negative symptoms of schizophrenia // Frontiers in Psychiatry. – 2024. – Vol. 15. – Art. 1385925. – https://doi.org/10.3389/fpsyt.2024.1385925
  14. Edinoff A., Ruoff M.T., Ghaffar Y.T. et al. Cariprazine to treat schizophrenia and bipolar disorder in adults // Psychopharmacology Bulletin. – 2020. – Vol. 50 (4). – Pp. 83–117.
  15. Li S., Xu C., Hu S. et al. Efficacy and tolerability of FDA-approved atypical antipsychotics for the treatment of bipolar depression: A systematic review and network meta-analysis // European Psychiatry. – 2024. – Pp. 1–26. –https://doi.org/10.1192/j.eurpsy.2024.25
  16. Barabássy Á., Sebe B., Acsai K. et al. Safety and tolerability of Cariprazine in patients with schizophrenia: a pooled analysis of eight phase II/III studies // Neuropsychiatric Disease and Treatment. – 2021. – Vol. 17. – Pp. 957–970. – https://doi.org/10.2147/NDT.S316858
  17. Masand P. S., McIntyre R. S., Cutler A. J. et al. Estimating changes in weight and metabolic parameters before and after treatment with Cariprazine: A retrospective study of electronic health records // Clinical Therapeutics. – 2024. – Vol. 46 (1). – Pp. 50–58. – https://doi.org/10.1016/j.clinthera.2023.10.015
  18. Croatto G., Vancampfort D., Miola A. et al. The impact of pharmacological and non-pharmacological interventions on physical health outcomes in people with mood disorders across the lifespan: An umbrella review of the evidence from randomised controlled trials // Molecular Psychiatry. – 2023. – Vol. 28 (1). – Pp. 369–390. – https://doi.org/10.1038/s41380-022-01770-w
  19. Durgam S., Litman R.E., Papadakis K. et al. Cariprazine in the treatment of schizophrenia: A proof-of-concept trial // International clinical psychopharmacology. – 2016. – Vol. 31 (2). – Pp. 61–68. – https://doi.org/10.1097/YIC.0000000000000110
  20. Nasrallah H. A., Earley W., Cutler A.J. et al. The safety and tolerability of Cariprazine in long-term treatment of schizophrenia: A post hoc pooled analysis // BMC Psychiatry. – 2017. – Vol. 17. – Pp. 1–13. – https://doi.org/10.1186/s12888-017-1459-z
  21. Kane J. M., Zukin S., Wang Y. et al. Efficacy and safety of cariprazine in acute exacerbation of schizophrenia: Results from an international, phase III clinical trial // Journal of Clinical Psychopharmacology. – 2015. – Vol. 35 (4). – Pp. 367–373. – https://doi.org/10.1097/JCP.0000000000000346
  22. Kadakia A., Dembek C., Heller V. et al. Efficacy and tolerability of atypical antipsychotics for acute bipolar depression: A network meta-analysis // BMC Psychiatry. – 2021. – Vol. 21 (1). – Art. 249. – https://doi.org/10.1186/s12888-021-03220-3
  23. Huhn M., Nikolakopoulou A., Schneider-Thoma J. et al. Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: A systematic review and network meta-analysis // The Lancet. – 2019. – Vol. 394 (10202). – Pp. 939–951. – https://doi.org/10.1016/S0140-6736(19)31135-3
  24. Greger J. Aladeen T., Lewandowski E. et al. Comparison of the metabolic characteristics of newer second generation antipsychotics: Brexpiprazole, Lurasidone, Asenapine, Cariprazine, and Iloperidone with Olanzapine as a comparator // Journal of Clinical Psychopharmacology. – 2021. – Vol. 41 (1). – Pp. 5–12. – https://doi.org/10.1097/JCP.0000000000001318
  25. Wu H., Siafis S., Hamza T. et al. Antipsychotic-induced weight gain: Dose-response metaanalysis of randomized controlled trials // Schizophrenia Bulletin. – 2022. – Vol. 48 (3). – Pp. 643–654. – https://doi.org/10.1093/schbul/sbac001
  26. Антохин Е.Ю., Васильева А.В., Антохина Р.И. Клиническая эффективность, переносимость и влияние на социальное функционирование карипразина и оланзапина при терапии больных с депрессивным синдромом, перенесших первый эпизод шизофрении // Современная терапия психических расстройств. – 2024. – № 1. – С. 11–23. – https://doi.org/10.21265/PSYPH.2024.60.81.002
  27. Li X.Q., Tang X.R., Li L.L. Antipsychotics cardiotoxicity: What’s known and what’s next // World J Psychiatry. – 2021. – Vol. 11 (10). – Pp. 736–753. – https://doi.org/10.5498/wjp.v11.i10.736
  28. Галкин С.А., Корнетова Е.Г., Меднова И.А. и др. Распространенность и факторы риска синдрома удлинения интервала QT у пациентов с шизофренией на фоне приема антипсихотиков // Современная терапия психических расстройств. – 2024. – № 2. – С. 32–39. – https://doi.org/10.21265/PSYPH.2024.31.31.004
  29. Малин Д.И., Рывкин П.В., Булатова Д.Р. Синдром удлиненного интервала QT при применении антипсихотических и антидепрессивных препаратов // Современная терапия психических расстройств. – 2023. – № 2. – С. 48–56. – https://doi.org/10.21265/PSYPH.2023.69.57.006
  30. Guo L., Yu S., Yang H. et al. Effects of metabolically healthy and unhealthy obesity on prolongation of corrected QT interval // The American Journal of Cardiology. – 2017. – Vol. 119 (8). – Pp. 1199–1204. – https://doi.org/10.1016/j.amjcard.2016.12.033
  31. Park B., Lee Y.J. Metabolic syndrome and its components as risk factors for prolonged corrected QT interval in apparently healthy Korean men and women // Journal of Clinical Lipidology. – 2018. – Vol. 12 (5). – Pp. 1298–1304. – https://doi.org/10.1016/j.jacl.2018.07.004
  32. Wang C.P., Hsu C.C., Hung W.C. et al. Plasma fatty acid-binding protein 4 (FABP4) level is associated with abnormal QTc interval in patients with stable angina and chronic kidney disease // BMC Cardiovascular Disorders. – 2019. – Vol. 19. – Pp. 1–11. –https://doi.org/10.1186/s12872-019-1134-z
  33. Лекарственно-индуцированный синдром удлиненного интервала QT в психиатрии и неврологии / под ред. Р.Ф. Насыровой, Н.Г. Незнанова, Н.А. Шнайдер, М.М. Петровой. – СПб.: ДЕАН, 2024. – 592 с.
  34. Friedrich M.E., Winkler D., Konstantinidis A. et al. Cardiovascular adverse reactions during antipsychotic treatment: Results of AMSP, a drug surveillance program between 1993 and 2013 // Int J Neuropsychopharmacol. 2020. – Vol. 23 (2). – Pp. 67–75. –https://doi.org/10.1093/ijnp/pyz046
  35. Малин Д.И., Булатова Д.Р., Шустова Л.Ю. и др. Распространенность и факторы риска синдрома удлинения интервала QT у пациентов городской психиатрической больницы // Современная терапия психических расстройств. – 2023. – № 3. – С. 50–56. – https://doi.org/ 10.21265/PSYPH.2023.60.92.006
  36. Клинические рекомендации «Желудочковые нарушения ритма. Желудочковые тахикардии и внезапная сердечная смерть» / Министерство здравоохранения Российской Федерации. – 2020. – URL: https://cr.minzdrav.gov.ru/schema/569_1#doc_a2 (дата обращения 25.07.2024).
  37. Khatib R. Sabir F.R.N., Omari C. et al. Managing drug-induced QT prolongation in clinical practice // Postgraduate Medical Journal. – 2021. – Vol. 97 (1149). – Pp. 452–458. – https://doi.org/ 10.1136/postgradmedj-2020-138661
  38. Rochester M.P., Kane A.M., Linnebur S.A. et al. Evaluating the risk of QTc prolongation associated with antidepressant use in older adults: A review of the evidence // Therapeutic Advances in Drug Safety. – 2018. – Vol. 9 (6). – Pp. 297–308. –https://doi.org/10.1177/2042098618772979
  39. Shnayder N.A., Kidyaeva A.V., Vaiman E.E. et al. Role of pharmacokinetics and pharmacogenetics of antidepressant-induced prolongation of the QT interval and Torsade de Pointes in patients with mental disorders // Personalized Psychiatry and Neurology. – 2023. – Vol. 3 (2). – Рp. 72–119. – https://doi.org/10.52667/2712-9179-2023-3-2-72-119
  40. Насырова Р.Ф., Кидяева А.В., Петрова М.М., Шнайдер Н.А. Антипсихотик-индуцированное удлинение интервала QT и развитие Torsade de Pointes у пациентов с психическими расстройствами: обзор // Безопасность и риск фармакотерапии. – 2024. –https://doi.org/10.30895/2312-7821-2024-410
  41. Orsolini L., De Berardis D., Volpe U. Up-to-date expert opinion on the safety of recently developed antipsychotics // Expert Opinion on Drug Safety. – 2020. – Vol. 19 (8). – Pp. 981–998. – https://doi.org/10.1080/14740338.2020.1795126
  42. Hope J., Keks N. A. Cariprazine: A new partial dopamine agonist with a familiar profile //Australasian Psychiatry. – 2022. –Vol. 30 (3). – Pp. 382–385. – https://doi.org/10.1177/10398562211064254
  43. CredibleMeds® – Available at: https://crediblemeds.org/druglist (accessed July 25, 2024).
  44. Zhuravlev N. M., Shnayder N.A., Vaiman E.E. et al. Interindividual variability of anticonvulsant-induced QT prolongation risk // Personalized Psychiatry and Neurology. – 2022. – Vol. 2 (1). – Pp. 22–45. – https://doi.org/10.52667/2712-9179-2022-2-1-23-45
  45. Andrade C. Practical psychopharmacology: Using a knowledge of pharmacokinetics to more rapidly stabilize patients at lower drug doses // The Journal of Clinical Psychiatry. – 2022. – Vol. 83 (6). – 22f14722. – https://doi.org/10.4088/JCP.22f14722
  46. Brouillette J., Nattel S. A practical approach to avoiding cardiovascular adverse effects of psychoactive medications // Canadian Journal of Cardiology. – 2017. – Vol. 33 (12). – Pp. 1577–1586. – https://doi.org/10.1016/j.cjca.2017.09.001
  47. Насырова Р.Ф., Кидяева А.В., Гречкина В.В., Шнайдер Н.А. и др. Персонализированный подход к прогнозированию и профилактике галоперидол-индуцированного удлинения интервала QT: короткий обзор // Фармакогенетика и фармакогеномика. – 2024. – № 1. – С. 20–30. – https://doi.org/10.37489/2588-0527-2024-1-20-30
  48. Cernea S., Dima L., Correll C.U. et al. Pharmacological management of glucose dysregulation in patients treated with second-generation antipsychotics // Drugs. – 2020. – Vol. 80 (17). – Pp. 1763–1781. – https://doi.org/10.1007/s40265-020-01393-x
  49. Мосолов С.Н., Цукарзи Э.Э., Алфимов П.В. Алгоритмы биологической терапии шизофрении // Современная терапия психических расстройств. – 2014. – № 1. – С. 27–36.
  50. Мосолов С.Н., Калинин В.В., Еремин А.В. Cравнительная эффективность и переносимость нового поколения антипсихотических средств при лечении обострений шизофрении (мета-анализ оригинальных исследований оланзапина, рисперидона, кветиапина, клозапина и галоперидола) // Новые достижения в терапии психических заболеваний. – М.: БИНОМ, 2002. – С. 82–94.
  51. DeBattista C., Schatzberg A.F. The Black book of psychotropic dosing and monitoring // Psychopharmacology Bulletin. – 2024. – Vol. 54 (3). – Pp. 8–59.
  52. Горобец Л.Н., Литвинов А.В. Карипразин: нейроэндокринные и метаболические аспекты переносимости у больных с психическими расстройствами // Современная терапия психических расстройств. – 2020. – № 3. – С. 19–27. – https://doi.org/10.21265/PSYPH.2020.79.49.003
  53. Мосолов С.Н., Цукарзи Э.Э. Психофармакотерапия шизофрении // Психиатрия: национальное руководство / под ред. Н.Г. Незнанова, А.Ю. Александровского. – М.: ГЭОТАРМедиа, 2018. – С. 299–328.
  54. Мазо Г.Э., Кибитов А.О. Риск-менеджмент метаболических нарушений при использовании антипсихотиков // Обозрение психиатрии и медицинской психологии имени В.М. Бехтерева. – 2016. – Т. 3. – С. 85–97.
  55. Шизофрения. Клинические рекомендации. Взрослые: Электронное издание / Минздрав РФ. – М., 2021. – 134 с. – URL: https://cr.minzdrav.gov.ru/recomend/451_2 (дата обращения 30.07.2024).

Downloads

Download data is not yet available.