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Cariprazine in the acute treatment of unipolar and bipolar depression: A systematic review and meta-analysis

Lookup NU author(s): Dr Ryan KennyORCiD, Alex InskipORCiD, Dr Fiona Pearson, Dr Stuart WatsonORCiD

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).

Abstract

© 2024 The AuthorsBackground: Cariprazine has emerged as a promising augmenting treatment agent for unipolar depression and as a monotherapy option for bipolar depression. We evaluated cariprazine's efficacy in treating acute major depressive episodes in individuals with major depressive disorder (MDD) or bipolar disorder. Methods: A systematic review was conducted on MEDLINE, Embase, PsycINFO, Scopus and Web of Science, ClinicalTrials.gov and ScanMedicine. Study quality was assessed using the RoB 2 tool. Pairwise and dose-response meta-analyses were conducted with RStudio. Evidence quality was assessed with GRADE. Results: Nine RCTs meeting inclusion criteria encompassed 4889 participants. Cariprazine, compared to placebo, significantly reduced the MADRS score (MD = −1.49, 95 % CI: −2.22 to −0.76) and demonstrated significantly higher response (RR = 1.21, 95 % CI: 1.12 to 1.30) and remission (RR = 1.19, 95 % CI: 1.06 to 1.34) rates. Subgroup analysis unveiled statistically significant reductions in MADRS score in MDD (MD = −1.15, 95 % CI: −2.04 to −0.26) and bipolar I disorder (BDI) (MD = −2.53, 95 % CI: −3.61 to −1.45), higher response rates for both MDD (RR = 1.19, 95 % CI: 1.08 to 1.31) and BDI (RR = 1.27, 95 % CI: 1.10 to 1.46), and higher remission rates only for BDI (RR = 1.41, 95 % CI: 1.24 to 1.60). A higher rate of treatment discontinuation due to adverse events was observed. Limitations: Reliance solely on RCTs limits generalisability; strict criteria might not reflect real-world diversity. Conclusions: Cariprazine demonstrates efficacy in treating major depressive episodes, although variations exist between MDD and BDI and tolerability may be an issue.

Publication metadata

Author(s): Martins-Correia J, Fernandes LA, Kenny R, Salas B, Karmani S, Inskip A, Pearson F, Watson S

Publication type: Article

Publication status: Published

Journal: Journal of Affective Disorders

Year: 2024

Volume: 362

Pages: 297-307

Print publication date: 01/10/2024

Online publication date: 26/06/2024

Acceptance date: 25/06/2024

Date deposited: 22/07/2024

ISSN (print): 0165-0327

ISSN (electronic): 1573-2517

Publisher: Elsevier B.V.

URL: https://doi.org/10.1016/j.jad.2024.06.099

DOI: 10.1016/j.jad.2024.06.099

PubMed id: 38942207

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