Ichinose Mizue, Miura Itaru, Horikoshi Sho, Yamamoto Shinnosuke, Kanno-Nozaki Keiko, Watanabe Kenya, Yabe Hirooki
Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima, Japan.
Department of Neuropsychiatry, Hoshigaoka Hospital, Koriyama, Japan.
Neuropsychiatr Dis Treat. 2021 Apr 13;17:1047-1053. doi: 10.2147/NDT.S306573. eCollection 2021.
Although switching antipsychotics is a common strategy in the treatment of schizophrenia, caution is needed because of the risk of worsening of psychosis, particularly when switching to a dopamine D2 partial agonist. Homovanillic acid (HVA), a dopamine metabolite, is thought to be a possible indicator of the response to antipsychotics. We examined the effects of switching to brexpiprazole monotherapy from other antipsychotics on plasma HVA levels and side effects during maintenance treatment of schizophrenia.
The antipsychotics of 37 Japanese patients with schizophrenia or schizoaffective disorder were switched to brexpiprazole for the improvement of side effects. We evaluated clinical symptoms and extrapyramidal symptoms (EPS) and took fasting blood samples at baseline and endpoint (eight weeks after completing the switch) to measure plasma levels of HVA, prolactin, and metabolic parameters.
Switching to brexpiprazole significantly decreased the Drug-Induced Extrapyramidal Symptoms Scale total score (p=0.008), prolactin levels (p<0.001), body weight (p=0.046), and body-mass index (p=0.034), and increased HDL cholesterol (p=0.008). On the other hand, switching to brexpiprazole did not change plasma levels of HVA or Positive and Negative Syndrome Scale scores.
Switching to brexpiprazole significantly improved EPS, high prolactin levels, and metabolic side effects without elevating plasma HVA levels. Brexpiprazole may stabilize dopaminergic neural transmission and could be a useful strategy to decrease the burden in patients with schizophrenia during the maintenance phase. Because of the small sample size, further studies with larger sample sizes are needed to confirm and extend our results.
尽管更换抗精神病药物是治疗精神分裂症的常用策略，但由于存在精神病症状恶化的风险，尤其是在换用多巴胺D2部分激动剂时，仍需谨慎。高香草酸（HVA）是一种多巴胺代谢产物，被认为可能是抗精神病药物反应的一个指标。我们研究了在精神分裂症维持治疗期间，从其他抗精神病药物换用布雷哌唑单药治疗对血浆HVA水平和副作用的影响。
37例日本精神分裂症或分裂情感性障碍患者为改善副作用而将抗精神病药物换用布雷哌唑。我们评估了临床症状和锥体外系症状（EPS），并在基线和终点（完成换药后8周）采集空腹血样，以测量血浆HVA、催乳素和代谢参数水平。
换用布雷哌唑后，药物所致锥体外系症状量表总分（p = 0.008）、催乳素水平（p < 0.001）、体重（p = 0.046）和体重指数（p = 0.034）显著降低，高密度脂蛋白胆固醇升高（p = 0.008）。另一方面，换用布雷哌唑并未改变血浆HVA水平或阳性和阴性症状量表评分。
换用布雷哌唑可显著改善EPS、高催乳素水平和代谢副作用，而不升高血浆HVA水平。布雷哌唑可能稳定多巴胺能神经传递，可能是减轻精神分裂症患者维持期负担的有效策略。由于样本量较小，需要进一步开展更大样本量的研究来证实和扩展我们的结果。
