Brexpiprazole in the Treatment of Major Depressive Disorder

Abstract

Brexpiprazole, a novel atypical antipsychotic agent, has recently been approved as an adjunctive treatment for major depressive disorder (MDD) when monotherapy only provides a partial response. The mechanism of action is likely related to its partial agonist activity at D 2 and 5-HT 1A receptors, as well as potent 5-HT 2A antagonist effects. The purpose of this systematic review is to provide a detailed overview available evidence on its role in treating MDD, based on all clinical publications in the English language between January 1, 2014 and April 30, 2017 identified from PubMed, Google Scholar, Scopus, Web of Science, PsycINFO, and ClinicalTrials.gov. Two primary pivotal trials are reviewed in detail and a further 10 supporting reviews and open-label studies are discussed. Brexpiprazole is compared with aripiprazole according to pharmacologic and clinical activities. Overall, this appears to be a useful antidepressant adjunctive therapy with a favorable side effect profile and comparable efficacy with existing agents.

Aiding and Abetting Anhedonia: Impact of Inflammation on the Brain and Pharmacological Implications

“…The body of evidence in support of atypical antipsychotics is larger than that for any other augmentation strategy in major depression. Meta-analyses of performed trials have identified that these agents are more effective than placebo for both response and remission (Nelson and Papakostas, 2009;Zhou et al, 2015), and two agents with DA receptor agonist activity-aripiprazole (Berman et al, 2007(Berman et al, , 2009Marcus et al, 2008;Fava et al, 2012) and brexpiprazole (Al Shirawi et al, 2017)-have received FDA approval for this indication. Although the typical antipsychotics are recognized as exerting their effect primarily through antagonism of the D2 receptor, newer-generation antipsychotics appear to have activity at multiple receptor sites.…”

<p>Impact of Atypical Antipsychotics as Adjunctive Therapy on Psychiatric Cost and Utilization in Patients with Major Depressive Disorder</p>

“…Brexpiprazole was approved in 2015 as an adjunctive therapy for adults in MDD and has been shown to be an effective and well-tolerated treatment. [10][11][12] In the only observational study that compared adjunctive brexpiprazole with lurasidone and quetiapine in MDD, there was no difference in psychiatric costs or hospitalization rates. 13 However, this study used 2015-2016 claims data and only followed patients for 6 months.…”