Summary

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• Brexpiprazole (Rexulti) is recommended for use alongside antidepressants for the management of major depressive disorder in adults, schizophrenia in adults and pediatric patients aged 13 years and older, and agitation associated with dementia due to Alzheimer's disease.
• Nineteen studies provided detailed analyses comparing brexpiprazole with other drugs such as aripiprazole and cariprazine regarding effectiveness and safety profiles.
• One study indicated that brexpiprazole might be effective at lower doses compared to aripiprazole in treating treatment-resistant depression, with the maximum effective dose being slightly lower (1.6 mg vs. 5.5 mg).
• In Japanese populations with Major Depressive Disorder, brexpiprazole showed comparable efficacy and safety profiles to aripiprazole but was associated with a risk of weight gain, especially at doses higher than 2mg/day.
• In the management of schizophrenia, lurasidone was found to be more effective compared to both brexpiprazole and cariprazine, suggesting it might be a preferable option, though brexpiprazole remains a viable alternative.
• As an adjunct therapy for refractory cases of Major Depressive Disorder, Rexulti was effective up to doses of 2mg while maintaining a balance between efficacy, tolerability, and acceptability.
• Brexpiprazole has been shown to cause mild weight gain (<1kg), suggesting it may have a better profile compared to antipsychotics that lead to significant weight gains, making it preferable for patients concerned about weight gain.
• In comparison, the association of brexpiprazole with akathisia seems less risky than cariprazine but similar or slightly more than aripiprazole, hence careful monitoring is recommended during its use.