The Position of Lurasidone in Schizophrenia Therapy − Current Conclusions and Consensus of the Expert Panel

Introduction

Lurasidone is a second-generation antipsychotic belonging to the group of SDAs. Its advantages include efficacy on positive, negative, cognitive, and affective symptoms of schizophrenia, including the depressive component, and it also has a low risk of metabolic side effects. In the Czech Republic, the drug is indicated for the acute and maintenance treatment of schizophrenia in adults and adolescents aged 13 years and older.

The objective of the study recently published by Italian authors was to define the use of lurasidone through responses to predetermined questions and to identify the most common clinical situations in which this therapy appears particularly advantageous.

Key Consensus Points

The advisory panel of leading Italian psychiatrists reached a consensus that lurasidone is an antipsychotic suitable for patients across all age groups, regardless of gender and stage of the disease. The absence of serious metabolic side effects, particularly weight gain, is especially valued by female patients. If sedation is needed during an exacerbation, benzodiazepines can be added to lurasidone therapy and later withdrawn. If necessary, the effective dose of lurasidone can be increased up to a daily maximum of 148 mg to achieve effective reduction of positive symptoms and agitation. The absence of sedative effects is beneficial in all stages of the disease but is particularly important in the initial phase to maintain long-term adherence to therapy and support cognitive functions of patients.

In Italy, lurasidone is often used as a first-line drug in previously untreated patients but also during transitions from another antipsychotic due to insufficient efficacy or low adherence to therapy, for instance, due to side effects. Lurasidone is among the very well-tolerated antipsychotics and can be used even in patients with additional comorbidities. Its administration is associated with minimal impact on lipid and glucose metabolism and the cardiovascular system (e.g., QT interval prolongation), making it a drug of choice for patients with metabolic syndrome, diabetes mellitus, dyslipidemia, obesity, or a positive cardiovascular disease history.

During lurasidone therapy, a very low discontinuation rate due to poor tolerability, low compliance, or drug interactions is observed. The most common reason for switching to another antipsychotic is the need for long-acting formulations, for example, in patients with very low adherence or a risk of suicide. The most frequent side effect is akathisia, which can be mitigated by dosage adjustment, comedication, or appropriate timing of administration.

The expert team also evaluated clinical situations in the second part of the study where lurasidone therapy appears particularly advantageous. These include the need to influence cognitive symptoms, treatment of patients with a history of metabolic and cardiovascular diseases, a broad dosing range for individualized therapy, good tolerability and safety during initial and maintenance therapy, efficacy on a wide range of symptoms, and the possibility of combination therapy with sedative drugs in agitated patients.

Conclusion

The results of the work of leading Italian psychiatrists indicate that lurasidone is an antipsychotic with comprehensive antipsychotic efficacy, good tolerability, and a safety profile, making it suitable for a wide range of patients suffering from schizophrenia.

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Source: Riva M. A., Albert U., de Filippis S. et al. Identification of clinical phenotypes in schizophrenia: the role of lurasidone. Ther Adv Psychopharmacol 2021 May 10; 11: 20451253211012250, doi: 10.1177/20451253211012250