Modern View on Schizophrenia Therapy Through the Lens of Lurasidone
At the psychiatric symposium titled 'Chance for a Better Quality of Life with a Schizophrenia Diagnosis', which took place on October 18, 2021, in Prague, Professor of Psychiatry and Molecular Biology Christoph U. Correll from the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell spoke. His lecture included insights on current approaches to schizophrenia therapy and key information on one of the newest antipsychotics - lurasidone.
Development and Changes in Schizophrenia Treatment Goals
The goals of schizophrenia treatment have drastically changed over the years. Today, the attention is not only focused on calming the patient and treating positive symptoms but also on addressing negative symptoms and side effects to restore the patient's quality of life. 'People may feel well, but are they better off? Recovery is the absolute threshold. And today, we call this remission,' began Prof. Correll. However, less than half of chronic patients achieve remission, and many patients experience relapses due to inadequate treatment efficacy and intolerance. Patients may discontinue medication, suffer relapse, and fall into an endless cycle of 'relapse - improvement - remission - deterioration,' which can cause secondary resistance to treatment. Patient recovery is determined by the long-term stability of symptoms and functioning in areas such as self-care, adequate psychosocial contact, and meaningful use of time.
Lurasidone in Clinical Studies
The efficacy of lurasidone has been proven in 5 placebo-controlled clinical trials. Eight out of ten different doses of lurasidone had positive outcomes, which is a remarkably high-quality result. According to head-to-head studies, lurasidone has comparable efficacy to olanzapine and quetiapine. Studies further showed that switching from olanzapine to lurasidone does not result in a loss of effect and that in the long term, lurasidone has a significant advantage over quetiapine in preventing hospitalization (9.8% vs. 23% probability of rehospitalization). Another presented study demonstrated that switching from risperidone to lurasidone did not result in loss of efficacy but improved the patients' body weight parameter.
When evaluating the impact on cognitive functions, lurasidone achieves promising results. In analyses, it was compared to ziprasidone and quetiapine in its effects on the cognitive sphere. The findings indicate that lurasidone shows greater efficacy in this regard compared to both medications and has a certain procognitive effect.
Dosage of Treatment
Prof. Correll participated in designing a study focused on the dosing of lurasidone. 'In all cases, the 148 mg per day dose outperforms the others. If tolerated, this is the appropriate dose that should be administered,' he explained the results. If a patient taking 74 mg does not respond to treatment after 14 days, doubling the dose to 148 mg has a very favorable effect, and it is not worth waiting. The dose of 18.5 mg is insufficient.
Side Effects
Among the side effects, weight gain, sedation, and cognitive deficit particularly bother patients. Therefore, medication generally should not reduce cognitive abilities or cause sedation and metabolic side effects to avoid discontinuation of the drug and subsequent relapse.
Lurasidone shows a small difference in the occurrence of side effects compared to placebo. There is a larger difference in the case of akathisia, where the timing of drug administration is crucial. The ideal time is to take the drug in the evening so that the patient sleeps through the peak effect, significantly reducing the occurrence of akathisia. Titrating the dose of the drug is also important as a prevention of early resistance.
A big problem in schizophrenia therapy is weight gain and metabolic effects of drugs, as they increase morbidity and mortality. Metabolic syndrome significantly increases the risk of relapse and, together with diabetes and hypertension, is associated with cognitive dysfunction. According to the meta-analysis presented, lurasidone ranks among the 5 safest antipsychotics in terms of cardiometabolic effects. Another study showed that it causes only a small weight gain compared to olanzapine (1.5 kg vs. 5 kg).
Conclusion
'We must prevent relapses by administering drugs that are well tolerated and ensure the patients' psychosocial functioning, prevent stigmatization, self-stigmatization, and secondary resistance to treatment. Early therapy with effective but also well-tolerated drugs is crucial,' concluded Professor Correll.
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Source: Correll C. U. Importance of social recovery in patients with schizophrenia. Symposium Chance for a Better Quality of Life with a Diagnosis of Schizophrenia, Prague, October 18, 2021. Available at: www.youtube.com/watch?v=QIOMg-RkzCA
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