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Adjunctive cariprazine for major depressive disorder: a systematic review and meta-analysis

Published online by Cambridge University Press:  01 April 2024

Hartej Gill Open the ORCID record for Hartej Gill [Opens in a new window] ,
David C.J. Chen-Li ,
Sipan Haikazian ,
Sam Seyedin ,
Roger S. McIntyre ,
Rodrigo B. Mansur ,
Joshua D. DiVincenzo ,
Lee Phan  and
Joshua D. Rosenblat
Hartej Gill*
Affiliation:
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada Institute of Medical Science, University of Toronto, Toronto, ON, Canada
David C.J. Chen-Li
Affiliation:
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada Institute of Medical Science, University of Toronto, Toronto, ON, Canada
Sipan Haikazian
Affiliation:
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada Institute of Medical Science, University of Toronto, Toronto, ON, Canada
Sam Seyedin
Affiliation:
Department of Psychiatry, University of Toronto, Toronto, ON, Canada
Roger S. McIntyre
Affiliation:
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada Institute of Medical Science, University of Toronto, Toronto, ON, Canada Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada Department of Pharmacology, University of Toronto, Toronto, ON, Canada Department of Psychiatry, University of Toronto, Toronto, ON, Canada Brain and Cognition Discovery Foundation, Toronto, ON, Canada
Rodrigo B. Mansur
Affiliation:
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada Department of Psychiatry, University of Toronto, Toronto, ON, Canada
Joshua D. DiVincenzo
Affiliation:
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada Brain and Cognition Discovery Foundation, Toronto, ON, Canada
Lee Phan
Affiliation:
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada Brain and Cognition Discovery Foundation, Toronto, ON, Canada
Joshua D. Rosenblat
Affiliation:
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada Institute of Medical Science, University of Toronto, Toronto, ON, Canada Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada Department of Pharmacology, University of Toronto, Toronto, ON, Canada Department of Psychiatry, University of Toronto, Toronto, ON, Canada
*
Corresponding author: Hartej Gill; Email: [email protected]
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Abstract

Converging evidence has suggested that treatment augmentation with a second-generation atypical antipsychotic (SGA) may improve treatment outcomes in major depressive disorder (MDD) patients after an incomplete response to a first-line antidepressant. Cariprazine is a recently approved SGA for MDD augmentation. Herein, we evaluate both continuous (ie, change in depressive symptom severity scores over time) and categorical (ie, remission and response rates) outcomes. Following a full-text review, four randomized controlled trials (RCTs) were included in our meta-analysis, while five studies were included for a qualitative review. Risk ratios (RRs) were calculated for all included randomized controlled studies to determine the relative response and remission rates of cariprazine compared to placebo augmentation. The RR for all-cause dropout was also determined as a proxy for overall acceptability. Two studies found a statistically significant treatment response using cariprazine augmentation. One study observed depressive symptom remission for cariprazine compared to placebo. Our random-effects model revealed moderate antidepressant effects of cariprazine, with a standardized mean difference (SMD) in Montgomery–Åsberg Depression Rating Scale (MADRS) scores of −1.79 (95% CI): −2.89, −0.69). Our pooled response RR and remission RR were calculated as 1.21 (95% CI: 1.05, 1.39, P=0.008) and 0.99 (95% CI: 0.84, 1.17, P=0.91), respectively. The RR for response was statistically significant (P<0.05). However, the RR for remission was not statistically significant. The findings from our meta-analysis include a variable magnitude of effects. Evidence suggests cariprazine may be an effective treatment for MDD; however, further results are needed to clarify this relation.

Keywords

Major depressive disorderReagilasecond-generation antipsychoticstreatment-resistant depressionVraylar
Type
Review
Information
CNS Spectrums , Volume 29 , Issue 4 , August 2024 , pp. 233 - 242
Copyright
© The Author(s), 2024. Published by Cambridge University Press

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Footnotes

H.G., D.C.J.C-L., and S.H. authors are co-first authors.

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