Himorogi Psychiatric Institute, Tokyo, Japan.
Medical Affairs, Otsuka Pharmaceutical Co. Ltd, Tokyo, Japan.
Drug Des Devel Ther. 2020 Dec 18;14:5559-5574. doi: 10.2147/DDDT.S240859. eCollection 2020.
While the prognosis of patients with schizophrenia has dramatically improved after the advent of chlorpromazine, the antipsychotics currently available are so numerous that it has become a challenge for psychiatrists to choose from among these drugs for each patient presenting for care. In addition, while numerous studies show that an effective antipsychotic should be continued indefinitely to prevent relapses or worsening, many patients appear to have difficulty remaining on any drug thus initiated. Brexpiprazole, a dopamine D receptor partial agonist, appears to provide a unique profile that has much to offer in this light. Specifically, this novel drug is potentially better suited for long-term use, with decreased risk of extrapyramidal side effects, hyperprolactinemia, weight gain, psychosis, insomnia, akathisia, nausea/vomiting or restlessness, thus potentially facilitating patients' reintegration into society. Indeed, brexpiprazole has been shown in randomized, double-blind, placebo-controlled trials to have proven efficacy not only in improving the symptoms of schizophrenia but in preventing relapses. It is also suggested in both short- and long-term studies that brexpiprazole offers a favorable safety and tolerability profile. This review also includes a proposed treatment algorithm incorporating brexpiprazole, based on the clinical trial results available, as well as on the authors' clinical experience, where brexpiprazole may be best used as a drug of first choice for the treatment of schizophrenia. Thus, overall, brexpiprazole appears to play a more significant role in the treatment of schizophrenia than other antipsychotics.
虽然氯丙嗪问世后精神分裂症患者的预后有了显著改善，但目前可用的抗精神病药物如此之多，以至于精神科医生在为每位就诊的患者选择药物时都面临挑战。此外，虽然许多研究表明，为了预防复发或病情恶化，应无限期地继续使用有效的抗精神病药物，但许多患者似乎难以坚持使用任何最初开的药物。布瑞哌唑是一种多巴胺 D 受体部分激动剂，它提供了一种独特的作用模式，有望在这方面发挥重要作用。具体而言，这种新型药物可能更适合长期使用，降低了锥体外系副作用、高催乳素血症、体重增加、精神病、失眠、静坐不能、恶心/呕吐或不安的风险，从而可能促进患者重新融入社会。事实上，在随机、双盲、安慰剂对照试验中，布瑞哌唑已被证明不仅能改善精神分裂症的症状，还能预防复发。在短期和长期研究中也表明，布瑞哌唑具有良好的安全性和耐受性。这篇综述还包括了一个基于现有临床试验结果和作者临床经验的治疗算法，其中布瑞哌唑可能是治疗精神分裂症的首选药物。因此，总体而言，布瑞哌唑在精神分裂症的治疗中似乎比其他抗精神病药物发挥更重要的作用。
