From the Guidelines
Rexulti (brexpiprazole) should not be considered a first-line treatment for obsessive-compulsive disorder (OCD) due to the lack of FDA approval for this specific condition and the availability of more established treatments like cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) 1. The most effective approach for treating OCD typically involves a combination of psychological interventions, particularly exposure and response prevention (ERP), a form of CBT, and pharmacological treatments such as SSRIs 1.
Key Considerations for OCD Treatment
- Cognitive Behavioral Therapy (CBT): CBT, especially ERP, is considered the psychological treatment of choice for OCD, offering significant symptom improvement in both adults and children 1.
- Selective Serotonin Reuptake Inhibitors (SSRIs): SSRIs are commonly used as first-line pharmacological treatments for OCD, often prescribed at higher doses than those used for depression.
- Rexulti (Brexpiprazole): While not FDA-approved for OCD, Rexulti might be considered off-label for patients who have not responded adequately to first-line treatments, typically as an augmentation strategy at doses ranging from 0.5 to 3 mg daily.
Important Factors in Treatment Decision
- Patient Adherence: Adherence to between-session homework, such as carrying out ERP exercises, is a robust predictor of good short-term and long-term outcomes with CBT 1.
- Comorbid Conditions: The presence of comorbid conditions can influence the choice between CBT and pharmacotherapy, with CBT being preferred in the absence of such conditions.
- Side Effects and Monitoring: Patients on Rexulti should be monitored for potential side effects including weight gain, akathisia, and metabolic changes, emphasizing the need for regular communication with healthcare providers about symptom changes and side effects.
From the Research
Rexulti for OCD
- Rexulti, also known as brexpiprazole, is an atypical antipsychotic that has been studied as an augmentation strategy for treatment-resistant obsessive-compulsive disorder (OCD) 2.
- A study published in 2024 found that brexpiprazole augmentation was effective and well-tolerated in 50% of OCD patients who had failed to respond to serotonin reuptake inhibitors (SRIs) 2.
- The study defined response as a 25% improvement in the Yale-Brown Obsessive Compulsive Scale (YBOCS) total score, and found that 17 out of 34 patients met this criteria 2.
- Another study published in 2013 compared the effects of cognitive-behavioral therapy (CBT) and risperidone augmentation in OCD patients who had failed to respond to SRIs, and found that CBT was superior to risperidone in reducing OCD symptoms 3.
- A review of pharmacological treatments for OCD published in 2019 found that SSRIs are the most effective treatment, and that augmentation with an atypical antipsychotic may be effective in refractory cases 4.
- A systematic review and meta-analysis published in 2014 found that behavioral therapy was more effective than SRIs in the treatment of OCD, and that the combination of behavioral therapy and an SRI was more effective than an SRI alone 5.
Efficacy and Safety
- The study on brexpiprazole augmentation found that it was well-tolerated, with no safety issues raised throughout the observation period 2.
- The most common adverse experiences reported were mild and did not require medical intervention 2.
- The study on CBT and risperidone augmentation found that CBT was superior to risperidone in improving insight, functioning, and quality of life, and had a more favorable adverse effect profile 3.
Treatment Guidelines
- The review of pharmacological treatments for OCD found that SSRIs are the first-line treatment, and that augmentation with an atypical antipsychotic may be considered in refractory cases 4.
- The systematic review and meta-analysis found that behavioral therapy should be considered as a first-line treatment, and that the combination of behavioral therapy and an SRI may be more effective than an SRI alone 5.