Summary

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• Vraylar (cariprazine) is indicated for the treatment of schizophrenia in adults, the acute treatment of manic or mixed episodes associated with bipolar I disorder in adults, the treatment of depressive episodes associated with bipolar I disorder (bipolar depression) in adults, and as adjunctive therapy to antidepressants for the treatment of major depressive disorder (MDD) in adults.
• This summary is based on the review of 28 systematic review(s)/meta-analysis(es). ^[1-28]
• Treatment-Resistant Depression (TRD): Cariprazine demonstrated moderate antidepressant effects with a standardized mean difference (SMD) in MADRS scores of -1.79 (95% CI: -2.89, -0.69) and improved MADRS response rates (RR = 1.19, 95% CI 1.08 to 1.31, P = 0.0004). However, remission rates were not significantly different (RR = 0.99, 95% CI: 0.84, 1.17).
• Major Depressive Disorder (MDD): Cariprazine showed better MADRS scores compared to control groups (SMD = -0.12, 95% CI -0.19 to -0.04) and improved response rates (RR = 1.19, 95% CI 1.08 to 1.31). It also demonstrated a moderate effect size in reducing depressive symptoms.
• Bipolar Depression: Cariprazine was effective in treating bipolar depression with standardized mean differences (SMDs) for depressive symptoms ranging from 0.41 to 0.16 and showed significant reductions in manic symptoms (SMD: -0.52). It was associated with higher remission (OR: 2.05) and response rates (OR: 2.31) for manic and mixed episodes.
• Schizophrenia: Cariprazine was effective for acute psychosis in schizophrenia, with a Hedges' g of 0.40 (95% CI 0.32-0.49) and showed significant superiority over placebo for treating schizophrenia.
• Cariprazine was associated with higher rates of adverse events compared to placebo, with common adverse events including akathisia, nausea, and extrapyramidal symptoms.
• Cariprazine had a higher incidence of adverse events compared to other second-generation antipsychotics (SGAs) like brexpiprazole and aripiprazole, but its safety profile was comparable to lurasidone and brexpiprazole in terms of cardiovascular and metabolic parameters for schizophrenia.
• Cariprazine showed a higher risk for akathisia compared to iloperidone, asenapine, and brexpiprazole, and while it caused less weight gain compared to olanzapine and quetiapine, the weight gain was still higher than with placebo.
• There is no population types or subgroups information available in the reviewed studies.