Nakamura Masaru, Nagamine Takahiko
Dr. Nakamura is with the Department of Psychiatric Internal Medicine, Kosekai-Kusatsu Hospital in Hiroshima, Japan.
Dr. Nagamine is with the Department of Psychiatric Internal Medicine, Sunlight Brain Research Center in Yamaguchi, Japan.
Innov Clin Neurosci. 2022 Apr-Jun;19(4-6):70-77.
Lurasidone is a second-generation antipsychotic (SGA) that contributes an antipsychotic and antidepressant effect, with low incidences of metabolic-related diseases and hyperprolactinemia for the treatment of psychological disorders. However, evidence on lurasidone is limited in psychiatric clinical settings. This study aimed to investigate the effect of short-term lurasidone treatment on metabolic effects and prolactin (PRL) levels, in relation to the differences of psychiatric disorders, lurasidone dosages, and introducing methods, in 35 female and 12 male Japanese inpatients with psychiatric disorders.
Subjects were placed into six subgroups divided by three categories (schizophrenia/schizoaffective disorder or bipolar disorder, 20mg/day or 40mg/day, adding or switching). Sequential changes in 10 items of metabolic parameters, including estimated insulin resistance and PRL levels at one month, were evaluated. The variations of metabolic parameters that were significantly changed from baseline were analyzed against sample characteristics and other metabolic parameter variations.
In the 40mg/day and switching introduction method groups, lurasidone significantly reduced body weight, body mass index (BMI), levels of alanine amiotransaminase, and levels of fasting blood glucose. PRL levels seemed to increase when lurasidone was added and decrease when lurasidone was switched to from other antipsychotics. Switching introduction method and higher dosage correlated with weight loss and lowering fasting blood glucose levels, respectively.
Lurasidone administration offered the potential for weight loss, lowered serum blood glucose levels, and converging serum PRL concentrations. Moreover, switching introduction method with higher dosages might alleviate basal metabolism and glucose homeostasis. Further prospective studies combining measurements of serum insulin and psychometric evaluation will help to confirm our conclusions.
鲁拉西酮是一种第二代抗精神病药物（SGA），具有抗精神病和抗抑郁作用，用于治疗心理障碍时，与代谢相关疾病和高催乳素血症的发生率较低。然而，在精神科临床环境中，关于鲁拉西酮的证据有限。本研究旨在调查短期使用鲁拉西酮治疗对35名日本女性和12名日本男性精神障碍住院患者代谢效应和催乳素（PRL）水平的影响，涉及精神障碍类型、鲁拉西酮剂量和引入方法的差异。
将受试者分为六个亚组，按三类进行划分（精神分裂症/分裂情感性障碍或双相情感障碍、每日20mg或40mg、加用或换药）。评估了包括估计胰岛素抵抗和一个月时PRL水平在内的10项代谢参数的连续变化。针对样本特征和其他代谢参数变化，分析了与基线相比有显著变化的代谢参数的变化情况。
在每日40mg组和换药引入方法组中，鲁拉西酮显著降低了体重、体重指数（BMI）、丙氨酸氨基转移酶水平和空腹血糖水平。加用鲁拉西酮时PRL水平似乎升高，从其他抗精神病药物换用鲁拉西酮时PRL水平似乎降低。换药引入方法和较高剂量分别与体重减轻和空腹血糖水平降低相关。
使用鲁拉西酮有可能减轻体重、降低血清血糖水平并使血清PRL浓度趋于正常。此外，较高剂量的换药引入方法可能会改善基础代谢和葡萄糖稳态。进一步结合血清胰岛素测量和心理测量评估的前瞻性研究将有助于证实我们的结论。
