Summary

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• This summary is based on the review of 19 systematic review(s)/meta-analysis(es). ^[1-19]
• Schizophrenia and Bipolar Disorder: Cariprazine effectively reduced global clinical severity and psychotic symptoms in schizophrenia and bipolar disorder patients, with higher doses yielding stronger improvements. Reductions included effect sizes for global clinical severity ranging from -0.25 (≤1.5 mg/day) to -0.45 (≥3 mg/day) and a mean difference (MD) in psychotic symptom scores of -6.74. Cariprazine also reduced depression (mean difference (MD) = -1.78), mania (MD = -5.72), and anxiety symptoms (MD = -1.24).
• Major Depressive Disorder (MDD) and Bipolar I Disorder (BDI): Cariprazine was associated with reductions in depression severity on the Montgomery-Asberg Depression Rating Scale (MADRS) scale (MD = -1.49) and showed increased response (relative risk (RR) = 1.21) and remission rates (RR = 1.19) compared to placebo. In the Beck Depression Inventory (BDI), the reduction in MADRS scores was more pronounced (MD = -2.53) than in MDD (MD = -1.15), with BDI patients experiencing higher response (RR = 1.27) and remission rates (RR = 1.41).
• Treatment-Resistant Depression (TRD): Cariprazine demonstrated limited effectiveness for TRD, with its maximum effective dose being 1.5 mg; lower doses of 0.5 to 1 mg were less effective, and both aripiprazole and brexpiprazole showed superior efficacy in TRD.
• Acute Mania in Bipolar Disorder: Cariprazine reduced manic symptoms, as measured by the YMRS score (standardized mean difference (SMD) = -0.52), with significant response (OR = 2.31) and remission rates (OR = 2.05), indicating its effectiveness in managing acute manic and mixed episodes in bipolar disorder.
• Discontinuation and Common Adverse Effects: Cariprazine was associated with higher treatment discontinuation rates due to adverse events compared to placebo in MDD and bipolar disorder studies, with common adverse effects including somnolence, weight gain, and metabolic disturbances.
• Extrapyramidal Side Effects (EPS): Cariprazine presented dose-dependent risks for EPS, with lower risk levels than haloperidol at high doses (maximum OR for haloperidol EPS = 7.56) but notable EPS risks relative to other antipsychotics, such as quetiapine and sertindole, which demonstrated lower EPS occurrence.
• Specific Adverse Events in Bipolar Disorder: Cariprazine had a lower rate of somnolence compared to quetiapine and caused moderate weight gain, less than olanzapine but higher than lurasidone and aripiprazole.
• The reviewed studies on cariprazine primarily involved adult populations with a median age of 31, covering both male and female participants with conditions including schizophrenia, bipolar I disorder, and major depressive disorder. In subgroup findings, cariprazine showed greater efficacy in bipolar I disorder compared to MDD, and real-world settings highlighted the impact of non-adherence in managing schizophrenia. Limited data were available for youth and geriatric populations, with recommendations for further study in these groups.