Lurasidone in the Treatment of Adolescent Schizophrenia: How Does It Compare with Other Atypical Antipsychotics?

Atypical Antipsychotics in the Treatment of Adolescent Schizophrenia

For adolescent patients with schizophrenia, atypical antipsychotics are recommended as first-line medications due to their lower risk of extrapyramidal symptoms and akathisia compared to typical antipsychotics. However, they form a heterogeneous group of drugs with various side effects, which may include weight gain, disturbances in glucose and lipid metabolism, elevation of prolactin, or sedation. Adolescents are particularly prone to metabolic abnormalities; therefore, monitoring of body weight, glycemia, and lipid profiles is recommended during treatment.

Network Meta-Analysis

The authors of a recent meta-analysis compared the efficacy and safety of lurasidone—a serotonin and dopamine antagonist—with other atypical antipsychotics in monotherapy for the treatment of schizophrenia in adolescents. Literature research was conducted up to June 2016. Randomized controlled trials involving patients aged 13-17 years with schizophrenia or other schizophrenia spectrum disorders (schizoaffective disorder, schizophreniform disorder, or unspecified psychosis) were included. A total of 13 studies were evaluated.

Using Bayesian network meta-analysis, lurasidone was compared with aripiprazole, asenapine, clozapine, olanzapine, extended-release (ER) paliperidone, quetiapine, risperidone, and ziprasidone. Measured parameters included the positive and negative symptom scores on the Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression - Severity (CGI-S) scores, weight gain, treatment discontinuation for any reason, and the occurrence of extrapyramidal symptoms and akathisia.

Results

Lurasidone demonstrated significantly greater efficacy in reducing PANSS scores from baseline (median difference -7.95; 95% credibility interval [CrI] -11.76 to -4.16) and CGI-S scores (-0.44; 95% CrI -0.67 to -0.22) compared to placebo. There was no significant difference in the effect on these scores between lurasidone and any of the compared atypical antipsychotics.

Weight gain with lurasidone was similar to that with placebo (median difference 0.26 kg; 95% CrI -0.26 kg to 0.82 kg) and significantly lower than with olanzapine (-3.62 kg; 95% CrI -4.84 kg to -2.41 kg), quetiapine (-2.13 kg; 95% CrI -3.20 kg to -1.08 kg), risperidone (-1.16 kg; 95% CrI -2.14 kg to -0.17 kg), asenapine (-0.98 kg; 95% CrI -1.71 kg to -0.24 kg), and paliperidone ER (-0.85 kg; 95% CrI -1.57 kg to -0.14 kg).

Lurasidone exhibited a lower probability of treatment discontinuation compared to aripiprazole (odds ratio [OR] 0.28; 95% CrI 0.10-0.76) and paliperidone ER (OR 0.25; 95% CrI 0.08-0.81).

The incidence of extrapyramidal symptoms and akathisia with lurasidone was similar to that of other atypical antipsychotics.

Conclusion

The results of this meta-analysis suggest that lurasidone has comparable efficacy to other atypical antipsychotics in adolescent patients with schizophrenia. It has a relatively favorable tolerability profile, with a lower risk of weight gain compared to asenapine, olanzapine, risperidone, paliperidone ER, and quetiapine. The incidence of extrapyramidal symptoms and akathisia is similar among all atypical antipsychotics. Treatment of schizophrenia with a favorable balance of efficacy and safety in adolescent patients can overall lead to better clinical outcomes in practice.

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Source: Arango C., Ng-Mak D., Finn E. et al. Lurasidone compared to other atypical antipsychotic monotherapies for adolescent schizophrenia: a systematic literature review and network meta-analysis. Eur Child Adolesc Psychiatry 2020; 29 (9): 1195-1205, doi: 10.1007/s00787-019-01425-2.