Brexpiprazole

Brexpiprazole
Clinical data
Trade names Rexulti
License data
Pregnancy
category
  • US: None assigned
Routes of
administration		 Oral (via tablets)
ATC code N05AX16 (WHO)
Legal status
Legal status
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
PubChem (CID) 11978813
ChemSpider 10152155
KEGG D10309 YesY
ChEMBL CHEMBL2105760
Chemical and physical data
Formula C25H27N3O2S
Molar mass 433.6 g/mol
3D model (Jmol) Interactive image

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.

Clinical trials

Brexpiprazole was in clinical trials for adjunctive treatment of MDD, adjunctive treatment of adult ADHD and schizophrenia.[8]

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.[9]

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)".[10] 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

Schizophrenia

Phase I

Phase II

Phase III

Conferences

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%).[21]

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.[22] It has negligible affinity for the mACh receptors.[22]

Receptor Ki (nM)[22] Pharmacodynamic action[22]
5-HT1A 0.12 Partial agonism
5-HT2A 0.47 Antagonist
5-HT2B 1.9 Antagonist
D2 0.30 Partial agonism
D3 1.1 Partial agonism
H1 19
α1B 0.17 Antagonist
α2C 0.59 Antagonist

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.
  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. ↑ Patent 5006528, Oshiro, Yasuo; Seiji Sato & Nobuyuki Kurahashi, "Carbostyril derivatives", published October 20, 1989
  6. ↑ "Patent and Exclusivity Search Results". Electronic Orange Book. US Food and Drug Administration. Retrieved 8 December 2008.
  7. ↑ "Lundbeck and Otsuka Pharmaceutical sign historic agreement to deliver innovative medicines targeting psychiatric disorders worldwide". Lundbeck. Retrieved 10 February 2012.
  8. ↑ "OPC-34712 search results". Retrieved 10 February 2012.
  9. ↑ "Study of the Safety and Efficacy of OPC-34712 as Adjunctive Therapy in the Treatment of Patients With Major". Retrieved 15 February 2012.
  10. ↑ "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.
  11. ↑ "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.
  12. ↑ "Trial to Evaluate the Effects of OPC-34712 on QT/QTc in Subjects With Schizophrenia or Schizoaffective Disorder". Retrieved 10 February 2012.
  13. ↑ "A Dose-finding Trial of OPC-34712 in Patients With Schizophrenia". Retrieved 10 February 2012.
  14. ↑ "Efficacy Study of OPC-34712 in Adults With Acute Schizophrenia (BEACON)". Retrieved 10 February 2012.
  15. ↑ "Safety and Tolerability Study of Oral OPC-34712 as Maintenance Treatment in Adults With Schizophrenia (ZENITH)". Retrieved 10 February 2012.
  16. ↑ "Study of the Effectiveness of Three Different Doses of OPC-34712 in the Treatment of Adults With Acute Schizophrenia (VECTOR)". Retrieved 10 February 2012.
  17. ↑ "A Long-term Trial of OPC-34712 in Patients With Schizophrenia". Retrieved 10 February 2012.
  18. ↑ "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.
  19. ↑ "Preclinical Pharmacology of Brexpiprazole (Opc-34712): A Novel Compound with Dopamine D2 Receptor Partial Agonist Activity". Retrieved 16 February 2012.
  20. ↑ "2011 U.S. Psych Congress Poster Session Abstracts". Retrieved 16 February 2012.
  21. ↑ "Otsuka Pharmaceutical reports OPC-34712 Phase 2 trial results in major depressive disorder". News-Medical.Net. Retrieved 10 February 2012.
  22. 1 2 3 4 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.
  23. ↑ "Canadian Patents Database 2620688". Retrieved 16 February 2012.
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