Can Brexpiprazole (Rexulti) cause weight gain?

From the Guidelines

Brexpiprazole (Rexulti) can cause weight gain as a side effect, although it is considered to have a lower risk for weight gain compared to other antipsychotics. The weight gain potential of brexpiprazole is not explicitly discussed in the provided evidence 1, but based on its classification as an atypical antipsychotic, it can be inferred that it may have some potential for weight gain. However, studies have shown that some atypical antipsychotics, such as lurasidone, ziprasidone, and aripiprazole, are more weight-neutral 1. Key points to consider:

• The risk of weight gain with brexpiprazole may be dose-dependent, with higher doses potentially leading to more significant weight gain.
• Regular monitoring of weight is crucial for patients starting brexpiprazole, especially during the first few months of treatment.
• Lifestyle modifications, including regular exercise and a balanced diet, may help mitigate weight gain associated with brexpiprazole.
• If weight gain becomes problematic, patients should discuss this with their healthcare provider to consider medication adjustments or alternative treatments. It is essential to weigh the benefits of brexpiprazole against its potential side effects, including weight gain, and to closely monitor patients to minimize adverse effects on morbidity, mortality, and quality of life 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.