The efficacy of cariprazine in negative symptoms of schizophrenia: Post hoc analyses of PANSS individual items and PANSS-derived factors

Abstract

Background:Negative symptoms in schizophrenia are heterogeneous and multidimensional; effective treatments are lacking. Cariprazine, a dopamine D3-preferring D3/D2 receptor partial agonist and serotonin 5-HT1A receptor partial agonist, was significantly more effective than risperidone in treating negative symptoms in a prospectively designed trial in patients with schizophrenia and persistent, predominant negative symptoms.Methods:Using post hoc analyses, we evaluated change from baseline at week 26 in individual items of the Positive and Negative Syndrome Scale (PANSS) and PANSS-derived factor models using a mixed-effects model for repeated measures (MMRM) in the intent-to-treat (ITT) population (cariprazine = 227; risperidone = 227).Results:Change from baseline was significantly different in favor of cariprazine versus risperidone on PANSS items N1-N5 (blunted affect, emotional withdrawal, poor rapport, passive/apathetic social withdrawal, difficulty in abstract thinking) (P <.05), but not on N6 (lack of spontaneity/flow of conversation) or N7 (stereotyped thinking). On all PANSS-derived negative symptom factor models evaluated (PANSS-Factor Score for Negative Symptoms, Liemburg factors, Khan factors, Pentagonal Structure Model Negative Symptom factor), statistically significant improvement was demonstrated for cariprazine versus risperidone (P <.01). Small and similar changes in positive/depressive/EPS symptoms suggested that negative symptom improvement was not pseudospecific. Change from baseline was significantly different for cariprazine versus risperidone on PANSS-based factors evaluating other relevant symptom domains (disorganized thoughts, prosocial function, cognition; P <.05).Conclusions:Since items representing different negative symptom dimensions may represent different fundamental pathophysiological mechanisms, significant improvement versus risperidone on most PANSS Negative Subscale items and across all PANSS-derived factors suggests broad-spectrum efficacy for cariprazine in treating negative symptoms of schizophrenia.

Abberant inverted U-shaped brain pattern and trait-related retinal impairment in schizophrenia patients with combined auditory and visual hallucinations: a pilot study

“…Total severity of schizophrenia was assessed by the Positive and Negative Symptoms Scale (PANSS) (Fleischhacker et al 2019). The scale for the Assessment of Positive Symptoms (SAPS) (Kumari et al 2017) was used to measure the severity of AHs and VHs.…”

“…Data from these 97 patients were used for analysis. Two independent psychiatrists with no involvement in the current study tested the validity of patient subtype divisions using the Auditory Hallucination Rating Scale (Haddock et al 1999) and the PANSS P3 VHs (Fleischhacker et al 2019) item to distinguish AH and VH severity. The four resulting symptom combination groups and diagnostic assessments of the psychiatrists affirmed our artificial divisions.…”

Reciprocal deterioration of visual and auditory hallucinations in schizophrenia presents V-shaped cognition impairment and widespread reduction in brain gray matter-A pilot study

“…The overall severity of schizophrenia was assessed using the Positive and Negative Symptoms Scale (PANSS) [19,20]. The scale for the Assessment of Positive Symptoms (SAPS) was used to measure the severity of AHs and VHs.…”

Cariprazine

“…Larger comparative studies with other atypical antipsychotics are missing until now. Based on the findings of previously published studies, an advantage of cariprazine in comparison to other antipsychotics was found, particularly in patients with predominantly "negative symptoms" and prolactin increases or weight gain [7,11]. Akathisia, one of the most common side effects, occasionally led to discontinuation of therapy in some studies [3][4][5].…”

“…Efficacy and safety of cariprazine in the treatment of schizophrenia were proven in four phase II/III studies [3][4][5][6]. Cariprazine was shown to be more effective in reducing negative symptoms of schizophrenia compared to risperidone [7]. Regarding safety and tolerability the available clinical trials suggest that the most frequently reported adverse events are extrapyramidal symptoms, insomnia, and akathisia [8].…”