AUTHOR=Lombardozzi Ginevra , Trovini Giada , Amici Emanuela , Kotzalidis Georgios D. , Perrini Filippo , Giovanetti Valeria , Di Giovanni Alessandro , De Filippis Sergio 

TITLE=Brexpiprazole in patients with schizophrenia with or without substance use disorder: an observational study

JOURNAL=Frontiers in Psychiatry

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2023.1321233

DOI=10.3389/fpsyt.2023.1321233

ISSN=1664-0640

ABSTRACT=Background. Partial dopamine D2 receptor agonists are used for psychotic symptoms in adults with schizophrenia spectrum disorders. Recent interest surged for partial dopamine D2 receptor agonists in substance use disorders (SUDs). Since it is believed that SUDs decrease the efficacy of pharmacotherapy of underlying psychiatric disorders, we tested the efficacy of the partial D2 agonist brexpiprazole in patients with schizophrenia who were either comorbid with a SUD (SUD group) or not comorbid (nonSUD) to assess treatment response and the effect of brexpiprazole on substance craving in SUD. Methods. We included patients with DSM-5/DSM-5-TR schizophrenia (using SCID-5-CV) aged 18-66 years with either comorbid SUD or nonSUD to treat with brexpiprazole 4 mg/day for 6 months during February-October 2022. Patients were assessed with the Clinical Global Impressions-Severity scale (CGI-S), the 24-item Brief Psychiatric Rating Scale (BPRS), and the Positive And Negative Syndrome Scale (PANSS) at baseline, weekly for the first two months and This is a provisional file, not the final typeset article monthly for the next four. Furthermore, we assessed substance craving in SUD with a Visual Analogue Scale for craving (VAScrav) at the same timepoints. Results. The total sample was 86 (85 analysable) 18 to 64-years-old (mean 39.32  14.09) patients with schizophrenia (51 men [59.3%] and 35 women [40.7%]), of whom 48 SUD (55.8%) (37 men and 11 women) and 38 nonSUD (44.2%) (14 men and 24 women). No serious or persistent adverse events developed over the study period, but one patient drop-out for subjective akathisia. Results indicated main effects of time with improvements over the course of the study for CGI-S, BPRS, PANSS in both SUD and nonSUD groups and in the entire sample, and for VAScrav in SUD. Brexpiprazole was associated with similar significant improvements in both groups at the 6-month endpoint compared to baseline. Conclusion. Treatment with brexpiprazole for 6 months improved psychotic symptoms similarly in patients with schizophrenia, independently from whether they belonged to the SUD or the nonSUD group; hence, SUD comorbidity did not confer treatment-resistance to brexpiprazole. Furthermore, in the SUD group we observed reduced substance craving.