Brexpiprazole

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Brexpiprazole
Brexpiprazole.svg
Systematic (IUPAC) name
7-{4-[4-(1-benzothiophen-4-yl)piperazin-1-yl]butoxy}quinolin-2(1H)-one
Clinical data
Trade names Rexulti
Licence data US FDA:link
Pregnancy
category
  • US: None assigned
Legal status
Routes of
administration		 Oral (via tablets)
Pharmacokinetic data
Bioavailability 95% (Tmax = 4 hours)[1]
Protein binding >99%
Metabolism Hepatic (mainly mediated by CYP3A4 and CYP2D6)
Biological half-life 91 hours (brexpiprazole), 86 hours (major metabolite)
Excretion Feces (46%), urine (25%)
Identifiers
CAS Number 913611-97-9 YesY
ATC code N05AX16 (WHO)
PubChem CID: 11978813
ChemSpider 10152155
KEGG D10309 YesY
ChEMBL CHEMBL2105760
Chemical data
Formula C25H27N3O2S
Molecular mass 433.6 g/mol
  • O=C5/C=C\c4ccc(OCCCCN3CCN(c1cccc2sccc12)CC3)cc4N5
  • InChI=1S/C25H27N3O2S/c29-25-9-7-19-6-8-20(18-22(19)26-25)30-16-2-1-11-27-12-14-28(15-13-27)23-4-3-5-24-21(23)10-17-31-24/h3-10,17-18H,1-2,11-16H2,(H,26,29)
  • Key:ZKIAIYBUSXZPLP-UHFFFAOYSA-N

Brexpiprazole (/brɛksˈpɪprəzoʊl/ breks-PIP-rə-zohl; brand name Rexulti recks-UL-tee, previously known as OPC-34712) is a novel atypical antipsychotic drug. It is a D2 dopamine partial agonist called 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 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 antipsychotic agent aripiprazole (brand names: Abilify, Aripiprex). Otsuka's US patent on aripiprazole expired on October 20, 2014;[5] however, due to a pediatric extension, a generic will become available in the near future.[6]

Partnership with Lundbeck

In November 2011, Otsuka and Lundbeck have announced a global alliance.[7] Lundbeck has given 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.

The partnership has been presented by Otsuka to its investors as a good fit for several reasons:[8]

  • Geographic strategy: Otsuka in Japan, Asia, US; Lundbeck in Europe, South America and emerging markets
  • Research strategy: Otsuka has knowledge in antipsychotics, Lundbeck in anti-depressant and anxiolytic.
  • CNS strategy: Otsuka has a robust portfolio in next-generation CNS drugs, while Lundbeck covers a wide range of CNS conditions from Alzheimer's to schizophrenia.
  • Similar corporate culture

Clinical trials

Brexpiprazole was in clinical trials for adjunctive treatment of MDD, adjunctive treatment of adult ADHD and schizophrenia.[9]

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.[10]

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)".[11] 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)[12] 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[13]

Phase II

  • A Dose-finding Trial of OPC-34712 in Patients With Schizophrenia[14]

Phase III

  • Efficacy Study of OPC-34712 in Adults With Acute Schizophrenia (BEACON)[15]
  • Safety and Tolerability Study of Oral OPC-34712 as Maintenance Treatment in Adults With Schizophrenia (ZENITH)[16]
  • Study of the Effectiveness of Three Different Doses of OPC-34712 in the Treatment of Adults With Acute Schizophrenia (VECTOR)[17]
  • A Long-term Trial of OPC-34712 in Patients With Schizophrenia[18]

Conferences

  • Phase II results were presented at the American Psychiatric Association's 2011 annual meeting in May 2011.[19]
  • The drug has been presented at the 2nd Congress of Asian College of Neuropsychopharmacology[20] 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[21]

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%).[22]

Drug 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

Brexpiprazole acts as a partial agonist of the 5-HT1A. D2, and D3 receptors. 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. It is also an antagonist of the 5-HT2A, 5-HT2B, 5-HT7, α1A-, α1B-, α1D-, and α2C-adrenergic, and H1 receptors.[23] It has negligible affinity for the mACh receptors.[23]

Receptor Ki (nM)[23] Pharmacodynamic action[23]
5-HT1A 0.12
5-HT2A 0.47
5-HT2B 1.9
D2L 0.30 Partial agonism
D3 1.1
H1 19
α1B 0.17
α2C 0.59

Dosage

  • As an adjunct to standard antidepressant therapy in adult patients with major depressive disorder:
    • Phase II trials: 1.5 ± 0.5 mg.
    • Phase III trials: 1 or 3 mg depending on group.[11]
  • For schizophrenic/schizoaffective subjects, dosage is 4 or 12 mg.[24]
  • For ADHD, the dose was thought to be 0.25 to 2 mg/day.[12]

Patents

See also

References

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  5. ↑ Patent 5006528, Oshiro, Yasuo; Seiji Sato & Nobuyuki Kurahashi, "Carbostyril derivatives", published October 20, 1989 
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  23. ↑ 23.0 23.1 23.2 23.3 Lua error in package.lua at line 80: module 'strict' not found.
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External links

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