Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Carlo Pepoli 5, 40123, Bologna, Italy.
Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
Eur Neuropsychopharmacol. 2019 Sep;29(9):971-985. doi: 10.1016/j.euroneuro.2019.06.008. Epub 2019 Jun 27.
Second generation antipsychotics (SGAs) are effective options in the treatment of schizophrenia and mood disorders, each with characteristic efficacy and safety features. In order to optimize the balance between efficacy and side effects, it is of upmost importance to match compound specificity against patient clinical profile. As the number of SGAs increased, this review can assist physicians in the prescription of three novel SGAs already on the market, namely lurasidone, brexpiprazole, cariprazine, and lumateperone, which is in the approval phase for schizophrenia treatment at the FDA. Besides schizophrenia, EMA and/or FDA approved lurasidone for bipolar depression, brexpiprazole as augmentation in major depressive disorder and cariprazine for the acute treatment of manic or mixed episodes associated with bipolar I disorder. These new antipsychotics were developed with the aim of improving efficacy on negative and depressive symptoms and reducing metabolic and cardiovascular side effects compared to prior SGAs, while keeping the risk of extrapyramidal symptoms low. They succeeded quite well in containing these side effects, despite weight gain during acute treatment remains a possible concern for brexpiprazole, while cariprazine and lurasidone show higher risk of akathisia compared to placebo and other SGAs such as olanzapine. The available studies support the expected benefits on negative symptoms, cognitive dysfunction and depressive symptoms, while the overall effect on acute psychotic symptoms may be similar to other SGAs such as quetiapine, aripiprazole and ziprasidone. The discussed new antipsychotics represent useful therapeutic options but their efficacy and side effect profiles should be considered to personalize prescription.
第二代抗精神病药物（SGAs）是治疗精神分裂症和心境障碍的有效选择，每种药物都具有独特的疗效和安全性特征。为了优化疗效和副作用之间的平衡，根据患者的临床特征来匹配化合物的特异性至关重要。随着 SGA 数量的增加，本文可以帮助医生开具三种已上市的新型 SGA 的处方，即鲁拉西酮、布瑞哌唑、卡利拉嗪和朗舒培，后者正在接受 FDA 治疗精神分裂症的批准。除了精神分裂症之外，EMA 和/或 FDA 还批准鲁拉西酮用于双相情感障碍的抑郁发作，布瑞哌唑用于重度抑郁障碍的增效治疗，卡利拉嗪用于双相 I 障碍急性治疗伴有躁狂或混合发作。这些新型抗精神病药物的开发旨在改善阴性和抑郁症状的疗效，并降低代谢和心血管副作用，同时保持锥体外系症状的风险低。它们在控制这些副作用方面相当成功，尽管在急性治疗期间体重增加仍然是布瑞哌唑可能存在的问题，而卡利拉嗪和鲁拉西酮与安慰剂和其他 SGA（如奥氮平）相比，出现静坐不能的风险更高。现有研究支持它们在改善阴性症状、认知功能障碍和抑郁症状方面的预期获益，而在急性精神病症状方面的总体疗效可能与其他 SGA（如喹硫平、阿立哌唑和齐拉西酮）相似。讨论中的新型抗精神病药物代表了有用的治疗选择，但应考虑其疗效和副作用特征来个性化处方。
