From the Guidelines
Rexulti (brexpiprazole) has a more favorable side effect profile compared to Abilify (aripiprazole), particularly in terms of lower risk of akathisia, extrapyramidal symptoms, and metabolic issues. When considering the advantages of Rexulti over Abilify, several key points emerge:
- Lower risk of activating side effects like insomnia, agitation, and anxiety
- Fewer extrapyramidal symptoms (movement disorders) due to its unique receptor binding profile
- Less likely to cause significant weight gain or metabolic issues, as seen in the comparison of antipsychotics in terms of weight gain, weight neutrality, and weight loss 1
- A longer half-life allowing for more stable blood levels and potentially better symptom control
- Dosing for Rexulti typically starts at 0.5-1mg daily and can be titrated up to 2-4mg daily, which may be beneficial for patients who require more flexible dosing However, it's essential to consider the cost difference, as Rexulti is generally more expensive than Abilify, especially with the availability of generic aripiprazole. In clinical practice, the choice between Rexulti and Abilify should be based on individual patient needs and medical history, prioritizing the minimization of side effects and optimization of symptom control.
From the Research
Advantages of Rexulti over Aripiprazole
The advantages of Rexulti (brexpiprazole) over Abilify (aripiprazole) can be summarized as follows:
- Lower propensity for activating adverse events and extrapyramidal symptoms due to less intrinsic activity at D2 receptors and potent actions at 5HT1A, 5HT2A, and noradrenaline α1B receptors 2
- Lower incidence of akathisia, insomnia, and agitation compared to aripiprazole, which may be attributed to its more potent antagonism at 5-HT2A receptors and D2 receptors partial agonism with lower intrinsic activity 3
- More tolerable side effect profile with regard to akathisia, extrapyramidal dysfunction, and sedation due to its pharmacological properties 4
- Moderate weight gain, which is more prominent than with aripiprazole, cariprazine, or ziprasidone, but with a lower incidence of metabolic abnormalities 3, 4
- Lower incidence of extrapyramidal symptoms, hyperprolactinemia, and tardive dyskinesia, with improvement effects on cognitive dysfunction 3
Comparison of Side Effects
In terms of side effects, brexpiprazole has been shown to have:
- A lower incidence of akathisia compared to aripiprazole 3, 4
- Less sedation compared to aripiprazole, but more than cariprazine 4
- Moderate weight gain, which is more prominent than with aripiprazole, cariprazine, or ziprasidone 3, 4
- A lower incidence of metabolic abnormalities compared to olanzapine 5
Clinical Efficacy
Brexpiprazole has been shown to be effective in the treatment of schizophrenia and major depressive disorder, with:
- Statistically significant and clinically meaningful improvements in overall symptomatology and psychosocial functioning compared to placebo in adults with acute exacerbation of schizophrenia 2
- Significant delay in the time to relapse compared to placebo in patients who were already stabilized on the drug 2
- Favorable results in double-blind placebo-controlled studies, with a number needed to treat (NNT) vs placebo of 6-15 for response in acute schizophrenia treatment and 4 for maintenance 4