Göran Hajak, MD, PhD, MBA, Professor of Psychiatry and Psychotherapy at the University of Regensburg, hosted a Product Theatre supported by Gedeon Richter and Recordati at the 29^th virtual meeting of the European Psychiatric Association about the clinical aspects of cariprazine in the treatment of schizophrenia.
 
Professor Hajak opened his presentation by showing data on the majority of first-episode schizophrenia patients experiencing a relapse in the subsequent years, warranting the need for designing “long-ahead” treatments.¹ He highlighted the potential of partial agonists, describing them as “smart drugs”, as they provide the activity needed at brain receptors depending on the environment.²

Prof Hajak then presented his first patient case about a 33-year-old first-episode man who lost his job due to paranoid thoughts. He received cariprazine, which was rapidly up-titrated to 4.5 mg/day in 3 days. Three months later, still on 4.5 mg, he got another job and 2 years later he was still in business. The effect observed in this acute patient – Prof Hajak pointed out — is supported by clinical data: from week 1 onwards, significant changes in total PANSS scores were observed in favour of cariprazine over placebo in randomized clinical studies.³ Cariprazine further outperformed placebo across all 5 symptom domains of schizophrenia (positive, negative, disorganised thought, hostility, depression/anxiety).⁴ Regarding long-term remission, cariprazine showed superiority over placebo as 21.6% of cariprazine patients versus 49.0% of placebo patients relapsed.⁵ 
 
The next patient Professor Hajak introduced was a 23-year-old male with at least 2 relapses/year since his diagnosis at 19. He was treated with risperidone long-acting injectable, but was hospitalised due to non-compliance. He can be considered a “difficult patient” – continued Prof Hajak – but why is he non-adherent to his medication? Firstly, because of his symptomatology – he displayed difficulties in all PANSS based negative symptom items, and most disorganised thought items. Secondly due to side effects: the patient reported a blockade of thinking and sexual dysfunction. He started receiving cariprazine, up-titrated to 3 mg/day in two weeks; his symptoms improved, and he has not had any hospitalisation since then.
 
Prof Hajak then went on to discuss evidence that supports the observed effects of cariprazine in patients with predominant negative symptoms, showing cariprazine’s superiority over risperidone in reducing negative symptoms from week 14 onwards.⁶ Cariprazine further brought significant improvements compared to risperidone in social functioning from week 10 onwards.⁶ Regarding cognition, cariprazine outperformed placebo in the acute⁷, and risperidone in the negative symptom population⁸, as measured by both the Marder and Meltzer factors.
 
Professor Hajak next listed common safety concerns among patients and doctors: QTc prolongation⁹, sedation⁹, prolactin elevation⁹, sexual dysfunction⁹, metabolic dysfunction¹⁰ and weight gain⁹. He presented data on how cariprazine has an advantageous safety profile, not causing significant changes in these aspects.^11,12
 
Lastly, Prof Hajak presented a patient case of a 32-year-old woman, who was switched to cariprazine 4.5 mg/day for one year, but ran out of medication for 8 days. Prof Hajak advised clinicians to relax in such cases, as cariprazine has a long-acting metabolite DDCAR whose half-life is 1-3 weeks: after a week without medication, only a minor decline in plasma levels is observed – and thus, the patient should not experience a relapse.¹³
 
In conclusion, Prof Hajak emphasised the most important aspects of cariprazine: it is efficacious in the treatment of positive, negative and cognitive symptoms, psychosocial functioning, has clear advantages regarding metabolic, cardiac and hormonal side effects and does not increase the relapse rate if the patient misses a dose.