Brexpiprazole

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Brexpiprazole
Brexpiprazole.svg
Brexpiprazole-optimized-ball-and-stick.png
Clinical data
Pronunciation /brɛksˈpɪprəzl/ breks-PIP-rə-zohl
reks-UL-tee
Trade names Rexulti
Synonyms OPC-34712
License data
  • US FDABrexpiprazole
Routes of
administration
Oral (tablets)
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability 95% (Tmax = 4 hours)[1]
Protein binding >99%
Metabolism Hepatic (mainly mediated by CYP3A4 and CYP2D6)
Elimination half-life 91 hours (brexpiprazole), 86 hours (major metabolite)
Excretion Feces (46%), urine (25%)
Identifiers
CAS Number
  • 913611-97-9 YesY
PubChem CID
  • 11978813
ChemSpider
  • 10152155
KEGG
  • D10309 YesY
ChEMBL
  • CHEMBL2105760
Chemical and physical data
Formula C25H27N3O2S
Molar mass 433.6 g/mol
3D model (JSmol)
  • Interactive image

Brexpiprazole, sold under the brand name Rexulti, is an atypical antipsychotic. It is a dopamine D2 receptor partial agonist and has been described as a "serotonin–dopamine activity modulator" (SDAM). The drug received FDA approval on July 13, 2015 for the treatment of schizophrenia, and as an adjunctive treatment for depression.[2] Although it failed Phase II clinical trials for attention-deficit hyperactivity disorder (ADHD), it has been designed to provide improved efficacy and tolerability (e.g., less akathisia, restlessness and/or insomnia) over established adjunctive treatments for major depressive disorder (MDD).[3]

The drug was developed by Otsuka and Lundbeck, and is considered to be a successor[4] of Otsuka's top-selling atypical antipsychotic aripiprazole (Abilify). Otsuka's U.S. patent on aripiprazole expired on October 20, 2014;[5] and a generic was approved in April, 2015.[6]

Medical uses

Brexpiprazole is used in the treatment of schizophrenia and as an adjunct for major depressive disorder.

Side effects

The most common adverse events associated with brexpiprazole (all doses of brexpiprazole cumulatively greater than or equal to 5% vs. placebo) were upper respiratory tract infection (6.9% vs. 4.8%), akathisia (6.6% vs. 3.2%), weight gain (6.3% vs. 0.8%), and nasopharyngitis (5.0% vs. 1.6%).[7]

Interactions

Based on information given on the consent forms, it seems brexpiprazole is a substrate of CYP2D6 and CYP3A4, like its predecessor aripiprazole. Participants in the clinical trials are advised to avoid grapefruit, Seville oranges and related citruses.

Pharmacology

Pharmacodynamics

Brexpiprazole[8][9]
Site Ki (nM) Action Ref
5-HT1A 0.12 Partial agonist [9]
5-HT1B 32 ND [9]
5-HT2A 0.47 Antagonist [9]
5-HT2B 1.9 Antagonist [9]
5-HT2C 12–34 Partial agonist [9]
5-HT5A 140 ND [9]
5-HT6 58 Antagonist [9]
5-HT7 3.7 Antagonist [9]
D1 160 ND [9]
D2L 0.30 Partial agonist [9]
D3 1.1 Partial agonist [9]
D4 6.3 ND [9]
D5 ND ND ND
α1A 3.8 Antagonist [9]
α1B 0.17 Antagonist [9]
α1D 2.6 Antagonist [9]
α2A 15 Antagonist [9]
α2B 17 Antagonist [9]
α2C 0.59 Antagonist [9]
β1 59 Antagonist [9]
β2 67 Antagonist [9]
β3 >10,000 ND [9]
H1 19 Antagonist [9]
H2 >10,000 ND [9]
H3 >10,000 ND [9]
mACh 52% at 10 µM ND [9]
  M1 67% at 10 µM ND [9]
  M2 >10,000 ND [9]
σ 96% at 10 µM ND [9]
SERT 65% at 10 µM Blocker [9]
NET 0% at 10 µM Blocker [9]
DAT 90% at 10 µM Blocker [9]
Values are Ki (nM). The smaller the value, the more strongly the drug binds to the site. Most or all data are for human cloned proteins.

Brexpiprazole acts as a partial agonist of the serotonin 5-HT1A receptor and the dopamine D2 and D3 receptors.[9] Partial agonists have both blocking properties and stimulating properties at the receptor they bind to. The ratio of blocking activity to stimulating activity determines a portion of its clinical effects. Brexpiprazole has more blocking and less stimulating activity than its predecessor, aripiprazole, which may decrease its risk for agitation and restlessness.[9] It is also an antagonist of the serotonin 5-HT2A, 5-HT2B, and 5-HT7 receptors and the α1A-, α1B-, α1D-, and α2C-adrenergic receptors.[9] The drug has negligible affinity for the muscarinic acetylcholine receptors, and hence has no anticholinergic effects.[9]

History

Partnership with Lundbeck

In November 2011, Otsuka and Lundbeck announced a global alliance.[10] Lundbeck gave Otsuka an upfront payment of $200 million, and the deal includes development, regulatory and sales payments, for a potential total of $1.8 billion. Specifically for OPC-34712, Lundbeck will obtain 50% of net sales in Europe and Canada and 45% of net sales in the US from Otsuka.

Clinical trials

Brexpiprazole was in clinical trials for adjunctive treatment of MDD, adult ADHD, bipolar disorder[11] and schizophrenia.[12]

Major depression

Phase II

The Phase II multicenter, double-blind, placebo-controlled study randomized 429 adult MDD patients who exhibited an inadequate response to one to three ADTs in the current episode. The study was designed to assess the efficacy and safety of brexpiprazole as an adjunctive treatment to standard antidepressant treatment. The antidepressants included in the study were desvenlafaxine, escitalopram, fluoxetine, paroxetine, sertraline, and venlafaxine.[13]

Phase III

A new Phase III study was in the recruiting stage: "Study of the Safety and Efficacy of Two Fixed Doses of OPC-34712 as Adjunctive Therapy in the Treatment of Adults With Major Depressive Disorder (the Polaris Trial)".[14] Its goal is "to compare the effect of brexpiprazole to the effect of placebo (an inactive substance) as add on treatment to an assigned FDA approved antidepressant treatment in patients with major depressive disorder who demonstrate an incomplete response to a prospective trial of the same assigned FDA approved ADT". Estimated enrollment was 1250 volunteers.

Adult ADHD

Phase II
  • Study of the Safety and Efficacy of OPC-34712 (brexpiprazole) as a Complementary Therapy in the Treatment of Adult Attention Deficit/Hyperactivity Disorder (STEP-A)[15] The company did not move the product to Phase III, and it is presumed this drug failed Phase II trials for the disorder.

Schizophrenia

Phase I
  • Trial to Evaluate the Effects of OPC-34712 (brexpiprazole) on QT/QTc in Subjects With Schizophrenia or Schizoaffective Disorder[16]
Phase II
  • A Dose-finding Trial of OPC-34712 in Patients With Schizophrenia[17]
Phase III
  • Efficacy Study of OPC-34712 in Adults With Acute Schizophrenia (BEACON)[18]
  • Safety and Tolerability Study of Oral OPC-34712 as Maintenance Treatment in Adults With Schizophrenia (ZENITH)[19]
  • Study of the Effectiveness of Three Different Doses of OPC-34712 in the Treatment of Adults With Acute Schizophrenia (VECTOR)[20]
  • A Long-term Trial of OPC-34712 in Patients With Schizophrenia[21]

Conferences

  • Phase II results were presented at the American Psychiatric Association's 2011 annual meeting in May 2011.[22]
  • The drug has been presented at the 2nd Congress of Asian College of Neuropsychopharmacology[23] in September 2011.
  • At the US Psychiatric and Mental Health Congress in November 2011 in Vegas, Robert McQuade presented the Phase II Trial results for Schizophrenia[24]

Society and culture

Patents

See also

References

  1. ^ "REXULTI® (brexpiprazole) Tablets, for Oral Use. Full Prescribing Information" (PDF). Rexulti (brexpiprazole) Patient Site. Otsuka Pharmaceutical Co., Ltd., Tokyo, 101-8535 Japan. Retrieved 15 July 2015. 
  2. ^ "FDA approves new drug to treat schizophrenia and as an add on to an antidepressant to treat major depressive disorder". FDA Newsroom. FDA. Retrieved 14 July 2015. [dead link]
  3. ^ "Otsuka Pharmaceutical Development & Commercialization, Inc". Bloomberg Businessweek. Retrieved 10 February 2012. 
  4. ^ "Otsuka HD places top priority on development of OPC-34712". Chemical Business Newsbase. January 3, 2011. Retrieved 10 February 2012. 
  5. ^ 5006528, Oshiro, Yasuo; Seiji Sato & Nobuyuki Kurahashi, "Carbostyril derivatives", published October 20, 1989 
  6. ^ "FDA approves first generic Abilify to treat mental illnesses". US Food and Drug Administration. Retrieved 15 December 2017. 
  7. ^ "Otsuka Pharmaceutical reports OPC-34712 Phase 2 trial results in major depressive disorder". News-Medical.Net. Retrieved 10 February 2012. 
  8. ^ Roth, BL; Driscol, J. "PDSP Ki Database". Psychoactive Drug Screening Program (PDSP). University of North Carolina at Chapel Hill and the United States National Institute of Mental Health. Retrieved 14 August 2017. 
  9. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag ah ai aj Maeda K, Sugino H, Akazawa H, et al. (September 2014). "Brexpiprazole I: in vitro and in vivo characterization of a novel serotonin-dopamine activity modulator". J. Pharmacol. Exp. Ther. 350 (3): 589–604. doi:10.1124/jpet.114.213793. PMID 24947465. 
  10. ^ "Lundbeck and Otsuka Pharmaceutical sign historic agreement to deliver innovative medicines targeting psychiatric disorders worldwide". Lundbeck. Retrieved 10 February 2012. 
  11. ^ "www.healio.com/psychiatry/bipolar-disorder/news/online/%7B7281829f-0895-4785-88bc-9c76235e095c%7D/otsuka-lundbeck-initiate-phase-3-trials-of-rexulti-for-bipolar-i-disorder". www.healio.com. Retrieved 2017-10-16. 
  12. ^ "OPC-34712 search results". Retrieved 10 February 2012. 
  13. ^ "Study of the Safety and Efficacy of OPC-34712 as Adjunctive Therapy in the Treatment of Patients With Major". Retrieved 15 February 2012. 
  14. ^ "Study of the Safety and Efficacy of Two Fixed Doses of OPC-34712 as Adjunctive Therapy in the Treatment of Adults With Major Depressive Disorder (the Polaris Trial)". Retrieved 10 February 2012. 
  15. ^ "Study of the Safety and Efficacy of OPC-34712 as a Complementary Therapy in the Treatment of Adult Attention Deficit/Hyperactivity Disorder (STEP-A)". Retrieved 10 February 2012. 
  16. ^ "Trial to Evaluate the Effects of OPC-34712 on QT/QTc in Subjects With Schizophrenia or Schizoaffective Disorder". Retrieved 10 February 2012. 
  17. ^ "A Dose-finding Trial of OPC-34712 in Patients With Schizophrenia". Retrieved 10 February 2012. 
  18. ^ "Efficacy Study of OPC-34712 in Adults With Acute Schizophrenia (BEACON)". Retrieved 10 February 2012. 
  19. ^ "Safety and Tolerability Study of Oral OPC-34712 as Maintenance Treatment in Adults With Schizophrenia (ZENITH)". Retrieved 10 February 2012. 
  20. ^ "Study of the Effectiveness of Three Different Doses of OPC-34712 in the Treatment of Adults With Acute Schizophrenia (VECTOR)". Retrieved 10 February 2012. 
  21. ^ "A Long-term Trial of OPC-34712 in Patients With Schizophrenia". Retrieved 10 February 2012. 
  22. ^ "Otsuka Pharmaceutical Co., Ltd. Announces Results from a Phase 2 Study of Investigational Product OPC-34712 as Adjunctive Therapy in Adults with Major Depressive Disorder". Retrieved 16 February 2012. 
  23. ^ "Preclinical Pharmacology of Brexpiprazole (Opc-34712): A Novel Compound with Dopamine D2 Receptor Partial Agonist Activity". Retrieved 16 February 2012. 
  24. ^ "2011 U.S. Psych Congress Poster Session Abstracts". Retrieved 16 February 2012. 
  25. ^ "Canadian Patents Database 2620688". Retrieved 16 February 2012. 
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