Current Treatment Options and Emerging Agents for Schizophrenia
New treatments for schizophrenia may improve symptom domains other than positive symptoms and reduce adverse effects. Learn more in this CME activity.
The currently available antipsychotics mostly treat the positive symptoms of schizophrenia and have at least one adverse effect as a potential liability. Encouraging data suggest potential efficacy for a variety of new agents for the treatment of total symptoms and/or specific symptom domains of schizophrenia. Mechanisms of action that are under investigation include dopamine D3 antagonism/serotonin 5-HT1A partial agonism; combined dopamine, serotonin, and glutamate modulation; phosphodiesterase 10A inhibition; trace amine-associated receptor-1 (TAAR1) agonism plus 5-HT1A agonism; 5-HT2A inverse agonism; sigma-2/5-HT2A antagonism; D-amino acid oxidase (DAAO) inhibition; glycine transporter-1 inhibition; vesicular monoamine transporter-2 antagonism; mu opioid antagonism added to olanzapine; and novel long-acting injectable antipsychotic formulations. It is hoped that ongoing and recently completed trials for agents with known and/or novel mechanisms of action will lead to approved treatments that effectively target the various symptom domains of schizophrenia, minimize the risk for a broad range of clinically relevant adverse effects, and improve functional outcomes for patients. Some novel treatments have already received approval for use in patients with schizophrenia. This brief report discusses recently approved novel agents and potential new treatment options for schizophrenia that are being investigated.
From the Series: The Schizophrenia Remission Roller Coaster: Using Long-Acting Injectable Antipsychotics to Improve Adherence and Enhance Potential for Functional Recovery
To cite: Correll CU. Current treatment options and emerging agents for schizophrenia. J Clin Psychiatry. 2020;81(3):MS19053BR3C.
To share: https://doi.org/10.4088/JCP.MS19053BR3C
© Copyright 2020 Physicians Postgraduate Press, Inc.
- Psychiatrists, NPs, PAs
After completing this educational activity, you should be able to:
- Distinguish between the pharmacokinetic profiles of current and emerging antipsychotics, including LAIs
Supported by educational grants from Alkermes, Inc.; Otsuka America Pharmaceutical, Inc., and Lundbeck.
Participants may receive credit by reading the activity, scoring 70% or higher on the posttest, and completing the evaluation.
RELEASE, REVIEW, AND EXPIRATION DATES
This brief report activity was published in March 2020 and is eligible for AMA PRA Category 1 Credit™ through March 31, 2022. The latest review of this material was February 2020.
STATEMENT OF NEED AND PURPOSE
The goals of schizophrenia treatment are to control symptoms, prevent relapse, and improve functioning and quality of life. For many patients, these goals are not being met. Evidence demonstrates that LAI antipsychotics are one of the most effective ways to prevent relapse in patients with schizophrenia, yet they remain underused. Health care providers infrequently discuss LAI antipsychotic options with their patients with schizophrenia. Clinicians also may overestimate adherence or not even assess it despite guideline recommendations. Patients with multiple relapses are often continued on oral medications, and few clinicians consider LAIs early in the course of illness. Health care providers need education on the efficacy, safety, and dosage/administration of LAIs, as well as on discussing LAIs with their patients. This activity was designed to meet the needs of participants in CME activities provided by the CME Institute of Physicians Postgraduate Press, Inc., who have requested information on schizophrenia.
DISCLOSURE OF OFF-LABEL USAGE
Dr Correll has determined that, to the best of his knowledge, the following drugs are not approved by the US Food and Drug Administration for the treatment of schizophrenia: ALKS 3831, BI-425809, cannabidiol, F17464, Lu AF11167, Lu AF35700, MK-8189, pimavanserin, RO5263397, roluperidone, samidorphan, SEP-363856, sodium benzoate, sodium nitroprusside, TAK-063, and TAK-831, and TV46000.
The faculty member agreed to provide a balanced and evidence-based presentation and discussed the topic and CME objective during the planning sessions. The faculty’s submitted content was validated by CME Institute staff, and the activity was evaluated for accuracy, use of evidence, and fair balance by a peer reviewer who is without conflict of interest.
This Brief Report is derived from the teleconference series “The Schizophrenia Remission Roller Coaster: Using Long-Acting Injectable Antipsychotics to Improve Adherence and Enhance Potential for Functional Recovery,” which was held in September and October 2019 and supported by educational grants from Alkermes, Inc.; Otsuka America Pharmaceutical, Inc., and Lundbeck.
Christoph U. Correll, MD
Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York, USA; Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
The faculty for this CME activity and the CME Institute staff were asked to complete a statement regarding all relevant personal and financial relationships between themselves or their spouse/partner and any commercial interest. The Accreditation Council for Continuing Medical Education (ACCME) defines a commercial interest as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The ACCME defines relevant financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. The CME Institute has resolved any conflicts of interest that were identified. No member of the CME Institute staff reported any relevant personal financial relationships. Faculty financial disclosure is as follows:
Dr Correll is a consultant for and received honoraria from Acadia, Alkermes, Allergan, Angelini, Axsome, Boehringer-Ingelheim, Gedeon Richter, Gerson Lehrman Group, Indivior, IntraCellular Therapies, Janssen, LB Pharma, Lundbeck, MedAvante-ProPhase, Medscape, Merck, Neurocrine, Noven, Otsuka, Pfizer, Recordati, ROVI, Servier, Sumitomo Dainippon, Sunovion, Supernus, Takeda, and Teva; has received grant/research support from Janssen and Takeda; is a member of the speakers/advisory boards for Alkermes, Allergan, Angelini, Gedeon Richter, IntraCellular Therapies, Janssen, LB Pharma, Neurocrine, Noven, Otsuka, Pfizer, Recordati, Sumitomo Dainippon, Sunovion, Supernus, Takeda, and Teva; is a stock option holder of LB Pharma; and has received other financial or material support for expert testimony from Bristol-Myers Squibb, Janssen, and Otsuka, and royalties from UpToDate.
The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.
To obtain credit for this activity, study the material and complete the CME Posttest and Evaluation.
MOC APPROVAL STATEMENT
Through the American Board of Medical Specialties (“ABMS”) ongoing commitment to increase access to practice relevant Continuing Certification Activities through the ABMS Continuing Certification Directory, Current Treatment Options and Emerging Agents for Schizophrenia has met the requirements as a MOC Part II CME Activity (apply toward general CME requirement) for the following ABMS Member Boards:
MOC PART II CME ACTIVITY
Psychiatry and Neurology
- 1.00 AMA PRA Category 1 Credit™
- 1.00 Participation