Can Brexpiprazole (Rexulti) cause weight gain?

From the Guidelines

Brexpiprazole (Rexulti) can cause weight gain, although it is considered to have a lower risk compared to some other antipsychotics. When considering the potential for weight gain with brexpiprazole, it's essential to look at the most recent and highest quality studies. According to the available evidence, brexpiprazole, like other atypical antipsychotics, can affect neurotransmitters that regulate appetite and metabolism, potentially leading to weight gain 1.

Key Points to Consider:

• The risk of weight gain with brexpiprazole is generally lower than with some other antipsychotics such as olanzapine, clozapine, quetiapine, and risperidone 1.
• Brexpiprazole's weight gain potential is more comparable to that of lurasidone and ziprasidone, which are considered to be among the more weight-neutral options in the class of antipsychotics 1.
• Regular monitoring of weight is recommended for patients taking brexpiprazole, and lifestyle modifications such as a healthy diet and regular exercise can help minimize the risk of weight gain.
• If significant weight gain occurs, discussing this with a healthcare provider is crucial, as adjustments to the treatment plan may be necessary 1.

Management of Weight Gain:

• Lifestyle modifications are the first line of defense against weight gain when taking brexpiprazole. This includes adopting a healthy eating plan and engaging in regular physical activity 1.
• Monitoring weight regularly can help in early detection of weight gain, allowing for timely intervention 1.
• Alternative medications or adjustments to the current medication regimen may be considered if weight gain becomes a significant issue 1.

From the FDA Drug Label

Weight Gain Weight gain has been observed in patients treated with atypical antipsychotics, including brexpiprazole. Monitor weight at baseline and frequently thereafter In the long-term, open-label depression studies, 4% of patients discontinued due to weight increase. Brexpiprazole was associated with mean change from baseline in weight of 2.9 kg at Week 26 and 3.1 kg at Week 52. In the long-term, open-label depression studies, 30% of patients demonstrated a ≥ 7% increase in body weight and 4% demonstrated a ≥ 7% decrease in body weight In the long-term, open-label schizophrenia studies in adult patients, 0.6% of patients discontinued due to weight increase. Brexpiprazole was associated with mean change from baseline in weight of 1.3 kg at Week 26 and 2.0 kg at Week 52. In the long-term, open label schizophrenia studies, 20% of patients demonstrated a ≥ 7% increase in body weight and 10% demonstrated a ≥ 7% decrease in body weight.

Yes, brexpiprazole (Rexulti) can cause weight gain, as evidenced by the mean change from baseline in weight and the percentage of patients with a ≥ 7% increase in body weight in the clinical studies 2.

• Key findings include:
  • 30% of patients in the long-term, open-label depression studies demonstrated a ≥ 7% increase in body weight
  • 20% of patients in the long-term, open-label schizophrenia studies demonstrated a ≥ 7% increase in body weight
  • Mean change from baseline in weight ranged from 1.3 kg to 3.1 kg in the long-term studies

From the Research

Weight Gain Associated with Brexpiprazole (Rexulti)

• Brexpiprazole has been associated with moderate weight gain in several studies 3, 4, 5.
• A study published in 2019 found that brexpiprazole was generally well tolerated, with a relatively low incidence of activating and sedating adverse effects, and moderate weight gain 3.
• Another study published in 2016 reported that the most commonly encountered adverse event with brexpiprazole was increased weight, with approximately 10% of patients gaining ≥7% body weight from baseline 4.
• A 2020 review of brexpiprazole's clinical efficacy and safety suggested that it may have a decreased risk of weight gain compared to other antipsychotics, although this was not consistently supported by all studies 6.
• A 2018 analysis of short-term and long-term studies found that brexpiprazole and aripiprazole had similar effects on body weight, with mean weight increases ranging from 1.2-3.2 kg for brexpiprazole and 0.6-4.0 kg for aripiprazole 7.

Comparison to Other Antipsychotics

• Brexpiprazole's weight gain profile is similar to that of aripiprazole, with both medications exhibiting moderate weight gain in clinical trials 4, 7.
• The weight gain associated with brexpiprazole is generally considered to be less severe than that of other antipsychotics, although more research is needed to fully characterize its weight gain profile 6, 5.

Clinical Implications

• Healthcare providers should monitor patients taking brexpiprazole for weight gain and adjust treatment as needed to minimize this risk 3, 4.
• The potential for weight gain should be considered when selecting brexpiprazole as a treatment option, particularly for patients with a history of weight-related issues or other risk factors for weight gain 5, 7.