• Asenapine: Pharmacological Aspects and Role in Psychiatric Disorders

      Antoun Reyad, Ayman; Mishriky, Raafat (Medicinska naklada, 2019-07-08)
      Schizophrenia and bipolar disorders are serious psychiatric disorders with substantial health risks. Asenapine is a new second-generation antipsychotic, available as a sublingual tablet, approved in Europe for the treatment of moderate-to-severe manic episodes in adults, and in US for manic or mixed episodes of bipolar I disorder in adults and adolescents. In this review, we searched the available literature to appreciate the role of asenapine in the management of psychiatric conditions such as bipolar disorders and schizophrenia and describe its mechanism of action, efficacy and tolerability. Asenapine has demonstrated efficacy in the management of bipolar disorders and schizophrenia, while a possible role in the management of borderline personality disorder and agitation needs further research. Asenapine has favourable side effects profile and combining with other pharmacological treatment in post-traumatic stress disorder has shown promising results. Asenapine fulfils important requirements of efficacy and tolerability as an anti-psychotic. These findings should support psychiatrists and pharmacists in the care of their patients while on asenapine.
    • Efficacy and safety of cariprazine in acute management of psychiatric disorders: a meta-analysis of randomized controlled trials

      Antoun Reyad, Ayman; Cooper, Hannah; Mishriky, Raafat (Medicinska naklada Zagreb, 2020-04-15)
      Background: Cariprazine is a new atypical antipsychotic drug approved for the treatment of schizophrenia and bipolar disorders. Methods: we searched the published randomized controlled-trials (RCT) to review cariprazine efficacy and tolerability using the databases (PubMed, EUDRACT, ClinicalTrials.gov and Cochrane Central Register of Controlled Trials) for cariprazine role in managing the following psychiatric conditions (schizophrenia, bipolar mania, bipolar depression and major depressive disorder). A meta-analysis was conducted using the identified 13 clinical trials to assess efficacy using with the outcomes: positive and negative syndrome scale (PANSS), clinical global impressions – severity of Illness (CGI-S), young mania rating scales (YMRS), Montgomery Asberg depression rating scale (MADRS) and Hamilton rating scale for depression (HAM-D). The risk of discontinuation due to adverse effects and common side effects were examined. Results: The mean difference in change from baseline for PANSS was -6.23 [95% Confidence Interval (CI) -7.18, -5.28] favoring cariprazine treatment (p<0.00001). Similarly, mean difference for CGI-S was -0.36 [95% CI -0.41, -0.30], YMRS -5.64 [95% CI -6.86, -4.43], MADRS -1.43 [95% CI -1.88, -0.99] and HAM-D -1.52 [95% CI -2.28, -0.76]. The risk ratio (RR) of discontinuing due to adverse events was 1.18 [95% CI 1.01, 1.38] meaning risk increased by 18% in cariprazine group with RR for EPS related side effects 2.82 [95% CI 2.47, 3.22] reflecting an increased risk of experiencing EPS related side effects by 182%. Cariprazine was also associated with an increased incidence of side effects such as akathisia, nausea and insomnia. Conclusion: Cariprazine demonstrates significant improvements in symptom intensity control in patients suffering from psychiatric conditions including schizophrenia, bipolar disorders and depression and is considered well-tolerated with similar rates of trials discontinuation; however, cariprazine was associated with a higher risk of EPS side effects. These findings will guide psychiatrists and pharmacists in their clinical role for supporting psychiatric patients care.