Transition from Risperidone to Lurasidone and Adjustment of Metabolic Profile in Patients with Stable Schizophrenia
Patients with schizophrenia have a higher risk of cardiometabolic diseases compared to the general population, which is further increased by certain antipsychotics. A recently published post hoc analysis assessed, among other things, the metabolic parameters of patients who switched from risperidone therapy to lurasidone.
Cardiovascular Disease as a Comorbidity of Schizophrenia
Cardiovascular disease is the leading cause of death in patients with schizophrenia. These patients have a significantly higher risk of metabolic syndrome, abdominal obesity, dyslipidemia, and hypertension compared to the general population. The prevalence of metabolic disorders also increases with the patient's age and the duration since the diagnosis of schizophrenia. Although the increased metabolic risk appears to be associated with schizophrenia itself, this risk further increases due to certain types of treatment, especially atypical antipsychotics.
Lurasidone is a second-generation antipsychotic with a high affinity for dopamine D2 receptors and serotonin 5-HT2A receptors. Compared to other atypical antipsychotics, it has a relatively favorable cardiometabolic profile, which was also observed in the presented study.
Study Methodology and Course
The long-term safety, tolerability, and efficacy of lurasidone (n = 399) were evaluated in patients with clinically stable schizophrenia in a 12-month double-blind clinical study controlled by risperidone (n = 190). This was followed by a 6-month open-label extension, in which 129 participants continued lurasidone therapy and 84 patients who originally took risperidone were switched to lurasidone therapy.
Results
During the double-blind phase, the incidence of adverse events during treatment was comparable in both groups (84.1% of patients on lurasidone, 84.2% treated with risperidone). The efficacy of treatment during the double-blind phase was comparable in both arms and was maintained during the open-label extension.
Lurasidone use was associated with minimal changes in metabolic parameters and prolactin levels, while risperidone treatment was associated with a clinically significant increase in prolactin levels and fasting glucose. At the end of the 12-month follow-up, the proportion of patients with metabolic syndrome was significantly lower in the lurasidone-treated group (25.5% vs. 40.4%; p = 0.02).
Patients switched from risperidone to lurasidone during the extension phase of the study experienced a significant decrease in weight and prolactin levels. At the end of the open-label extension, the difference in the number of occurrences of metabolic syndrome between the groups was no longer significant (23.5% vs. 31.5%).
Conclusion
Lurasidone was long-term effective and well-tolerated in patients with clinically stable schizophrenia. Patients switched from risperidone therapy also tolerated it well, with adjustments in metabolic parameters and prolactin levels. The results of the presented study support the use of lurasidone in patients with schizophrenia in the context of overall health care, both physical and mental.
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Source: Patel P. J., Weidenfeller C., Jones A. P. et al. Long-term assessment of lurasidone in schizophrenia: post hoc analysis of a 12-month, double-blind, active-controlled trial and 6-month open-label extension study. Neurol Ther 2021; 10 (1): 121−147, doi: 10.1007/s40120-020-00221-4.
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