Lurasidone Augmentation of Clozapine in Refractory Schizophrenia

Abstract

PurposeClozapine represents the criterion standard therapy for patients with treatment-resistant schizophrenia. Unfortunately, a significant percentage of such patients are also partial responders to clozapine. Consequently, several augmentation strategies have been proposed with various and sometimes controversial efficacy. Among these add-on treatments, lurasidone has been recently introduced and could represent a potential option, especially for the additional positive effect on cognitive symptoms.MethodsThis case series aims to determine possible advantages of lurasidone augmentation in four patients treated with clozapine, who were diagnosed with treatment-resistant schizophrenia. Positive and Negative Syndrome Scales were used to evaluate psychopathology, the Udvalg for Kliniske Undersøgelser scale for tolerability and safety.FindingAll patients achieved a significant reduction of both positive and negative symptoms, with no significant adverse effects to be reported.ImplicationsOur observation suggests that lurasidone can lead to clinically significant improvements in psychopathology with a good tolerability profile when added to clozapine.

The Role of Lurasidone in Managing Depressive Symptoms in People with Schizophrenia: A Review

“…Moreover, Ricci et al [ 39 ] described in a case series the use of lurasidone in treating depressive symptoms in patients with schizophrenia and cannabis. In a case series on patients with treatment-resistant schizophrenia receiving clozapine by Olivola et al [ 47 ], all patients received lurasidone as add-on treatment and therefore achieved a significant reduction of both positive and negative symptoms, with no significant adverse effects.…”

“…The presence of side effects has been specifically evaluated only in the study by Olivola et al [ 47 ] using the Udvalg for Kliniske Undersøgelser Side Effect Rating Scale (UKU-SERS), while another study included the evaluation of the levels of satisfaction with medication using the Medication Satisfaction Questionnaire [ 45 ].…”

The Role of Case Series and Case Reports in Evidence-Based Medicine

“…A patient or clinician may want to try a combination of medications that has not been tested in an adequate trial, or a patient may enter a clinician's care already on such a medication combination. The example reviewed by Armstrong and Preskorn 1 concerning lurasidone augmentation of clozapine 2 is one example of a case report/series of this type. Checking the more established literature before concluding that evidence from case series or reports needs to be used is advised, because the number of trials evaluating medication combinations is increasing over time.…”

“…Their editorial focuses on a particular case series about lurasidone augmentation of clozapine. 2 Inspired by their example, we wanted to give a broader summary of what we view as the general role of case series and case reports in evidence-based medicine (especially evidence-based psychiatry). As we will make clear, this role is typically extremely limited.…”

“…Drs Austin Armstrong and Sheldon Preskorn's excellent editorial in a recent issue of the Journal of Clinical Psychopharmacology 1 reviews some of the principal limitations (as well as a few benefits) of case series. Their editorial focuses on a particular case series about lurasidone augmentation of clozapine 2 …”