The efficacy of cariprazine in negative symptoms of schizophrenia: Post hoc analyses of PANSS individual items and PANSS-derived factors

Wolfgang Fleischhacker, Silvana Galderisi, István Laszlovszky, Balázs Szatmári, Ágota Barabássy, Károly Acsai, Erzsébet Szalai, Judit Harsányi, Willie Earley, Mehul Patel, György Németh

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Abstract

Background: Negative symptoms in schizophrenia are heterogeneous and multidimensional; effective treatments are lacking. Cariprazine, a dopamine D 3 -preferring D 3 /D 2 receptor partial agonist and serotonin 5-HT 1A receptor partial agonist, was significantly more effective than risperidone in treating negative symptoms in a prospectively designed trial in patients with schizophrenia and persistent, predominant negative symptoms. Methods: Using post hoc analyses, we evaluated change from baseline at week 26 in individual items of the Positive and Negative Syndrome Scale (PANSS) and PANSS-derived factor models using a mixed-effects model for repeated measures (MMRM) in the intent-to-treat (ITT) population (cariprazine = 227; risperidone = 227). Results: Change from baseline was significantly different in favor of cariprazine versus risperidone on PANSS items N1-N5 (blunted affect, emotional withdrawal, poor rapport, passive/apathetic social withdrawal, difficulty in abstract thinking) (P <.05), but not on N6 (lack of spontaneity/flow of conversation) or N7 (stereotyped thinking). On all PANSS-derived negative symptom factor models evaluated (PANSS-Factor Score for Negative Symptoms, Liemburg factors, Khan factors, Pentagonal Structure Model Negative Symptom factor), statistically significant improvement was demonstrated for cariprazine versus risperidone (P <.01). Small and similar changes in positive/depressive/EPS symptoms suggested that negative symptom improvement was not pseudospecific. Change from baseline was significantly different for cariprazine versus risperidone on PANSS-based factors evaluating other relevant symptom domains (disorganized thoughts, prosocial function, cognition; P <.05). Conclusions: Since items representing different negative symptom dimensions may represent different fundamental pathophysiological mechanisms, significant improvement versus risperidone on most PANSS Negative Subscale items and across all PANSS-derived factors suggests broad-spectrum efficacy for cariprazine in treating negative symptoms of schizophrenia.

Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalEuropean Psychiatry
Volume58
DOIs
Publication statusPublished - May 2019

Keywords

  • Cariprazine
  • Cognition
  • Negative symptoms
  • PANSS
  • Risperidone
  • Schizophrenia

ASJC Scopus subject areas

  • Psychiatry and Mental health

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    Fleischhacker, W., Galderisi, S., Laszlovszky, I., Szatmári, B., Barabássy, Á., Acsai, K., Szalai, E., Harsányi, J., Earley, W., Patel, M., & Németh, G. (2019). The efficacy of cariprazine in negative symptoms of schizophrenia: Post hoc analyses of PANSS individual items and PANSS-derived factors. European Psychiatry, 58, 1-9. https://doi.org/10.1016/j.eurpsy.2019.01.015