Improvement in social functioning of patients with schizophrenia during treatment with lurasidone
A beneficial impact on social functioning is an important outcome of schizophrenia treatment. A recently published Japanese study is the first to demonstrate the efficacy of lurasidone compared to placebo on the social functioning of patients with schizophrenia. The results are comparable to other atypical antipsychotics.
Introduction
Schizophrenia manifests with positive symptoms (e.g., delusions and hallucinations) as well as negative symptoms (e.g., apathy) and is often accompanied by depressive symptomatology and cognitive deficit. A deficit in social functioning also appears from the first stages of the disease and usually persists long-term.
Lurasidone is a second-generation antipsychotic approved for the treatment of schizophrenia in adults and adolescents. Despite extensive evidence of its efficacy, little attention has been paid to its impact on patients' social functioning. The evaluation of this effect of lurasidone was therefore one of the goals of the 6-week double-blind, placebo-controlled JEWEL study with a subsequent 12-week open-label extension.
Evaluated patient population
In the post hoc data analysis of this study, 478 patients with schizophrenia (according to DSM-IV-TR criteria) were randomized to receive lurasidone 40 mg/day (n = 245) or placebo (n = 233) in the initial 6-week double-blind, placebo-controlled part of the study. Of these patients, 146 originally randomized to lurasidone and 141 originally randomized to placebo continued into the extended open-label 12-week period, during which all received lurasidone in a flexible dose of 40–80 mg/day.
The change in social functioning was evaluated according to the 4-item social scale within the Positive and Negative Syndrome Scale (PANSS).
Results
After 6 weeks of treatment under double-blind conditions, there was a significantly greater improvement in the PANSS social subscale in the lurasidone group compared to placebo (a decrease of 3.0 vs. 2.1 points; p < 0.01; effect size = 0.33). A significant difference compared to placebo was observed as early as the second week of treatment (p < 0.05) and remained evident in the fourth week (p < 0.001) and fifth week (p < 0.01) of the controlled assessment.
In patients who continued with lurasidone treatment, the PANSS social subscale score decreased by another 1.2 points after 12 weeks of extension, a total decrease of 4.2 points from study entry. For those who switched from placebo to lurasidone, the PANSS social subscale score decreased by a total of 3.7 points, corresponding to a decrease of 1.6 points during the 12 weeks of lurasidone use.
Conclusion
The authors concluded that lurasidone at a dose of 40 mg/day leads to significantly greater improvement in social functioning in patients with schizophrenia compared to placebo during 6 weeks, and this efficacy further deepens during an additional 12 weeks of treatment at a flexible dose of 40–80 mg. The effect size of lurasidone on improving social functioning (0.33) was comparable to the results of a meta-analysis of 10 placebo-controlled short-term studies assessing the efficacy of other antipsychotics on this aspect of schizophrenia, where the effect size was 0.34.
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Source: Miura I., Sano F., Sakaguchi R. et al. Effect of lurasidone on social functioning in schizophrenia: post hoc analysis of the JEWEL Study. J Clin Psychiatry 2024 Jan 31; 85 (1): 23m14881, doi: 10.4088/JCP.23m14881.
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