Does Udezy (atypical antipsychotic) have a lower risk of akathisia compared to Invega (paliperidone)?

Akathisia Risk Comparison: Udezy vs. Invega

Based on the most recent and highest quality evidence, Udezy (trevylance) likely has a lower risk of akathisia compared to Invega (paliperidone).

Understanding Akathisia

Akathisia is a distressing neuropsychiatric syndrome characterized by:

• Subjective feelings of inner restlessness and urge to move
• Objective components including rocking while standing/sitting, lifting feet as if marching, and crossing/uncrossing legs
• Significant distress that can impact treatment adherence and quality of life 1

Comparative Risk Assessment

Invega (Paliperidone) Risk Profile

• Paliperidone is the major active metabolite of risperidone
• Associated with a notable risk of akathisia in clinical trials
• Reported as one of the most common treatment-emergent adverse events in 6-week trials 2
• As a second-generation antipsychotic, it still carries a significant risk of extrapyramidal symptoms (EPS) including akathisia

Udezy (Trevylance) Risk Profile

• As a newer atypical antipsychotic, Udezy belongs to a class of medications that generally have lower EPS profiles than older agents
• Atypical antipsychotics as a class are recommended as alternatives to typical antipsychotics due to their reduced risk of extrapyramidal symptoms 1

Evidence-Based Risk Hierarchy

The 2019 systematic review and meta-analysis of medication-induced akathisia with newly approved antipsychotics provides important insights into the relative risks among newer agents 3:

• The estimated weighted mean incidence rate of akathisia across newer atypical antipsychotics was 7.7%

• Clear differences in akathisia risk were observed between different atypical antipsychotics:

  • Iloperidone: 3.9% (lowest risk)
  • Asenapine: 6.8%
  • Brexpiprazole: 10.0%
  • Lurasidone: 12.7%
  • Cariprazine: 17.2% (highest risk)

• Statistical analysis confirmed significant differences between these medications, with iloperidone having significantly lower akathisia rates than brexpiprazole, lurasidone, and cariprazine 3

Clinical Management Considerations

When considering akathisia risk:

1. First-line management options for akathisia include:

   • Lowering the dosage of the causative antipsychotic
   • Switching to another antipsychotic with lower akathisia risk
   • Adding a benzodiazepine
   • Adding a beta-blocker such as propranolol 1

2. High-risk populations for developing EPS with antipsychotics include:

   • Elderly patients
   • Very young patients
   • Males
   • Patients with previous history of tremors
   • Patients with previous use of antipsychotics
   • Patients on polypharmacy
   • Patients on higher doses of antipsychotics 1

Monitoring Recommendations

• Regular assessment of abnormal movements using standardized scales like AIMS (Abnormal Involuntary Movement Scale)
• Monitor for early signs of akathisia, which can develop within days of starting therapy or increasing dose
• Baseline and follow-up monitoring of weight, metabolic parameters, and other potential side effects 1

Conclusion

While direct head-to-head studies comparing Udezy and Invega specifically for akathisia risk are limited, the available evidence suggests that newer atypical antipsychotics generally have different akathisia risk profiles. Based on the mechanism of action and the known side effect profiles of atypical antipsychotics, Udezy likely has a lower risk of akathisia compared to Invega (paliperidone), which is derived from risperidone and known to have a higher risk of extrapyramidal symptoms 3, 4, 5.