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Adjunctive Brexpiprazole: A Review in Major Depressive Disorder.

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  • 1Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand. demail@springer.com.

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Brexpiprazole (Rexulti) offers a new option for major depressive disorder (MDD) when antidepressants alone are insufficient. This serotonin-dopamine modulator effectively improved symptoms in clinical trials with good tolerability.

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Area of Science:

  • Psychiatry
  • Pharmacology

Background:

  • Major depressive disorder (MDD) often requires combination therapy for treatment-resistant cases.
  • Brexpiprazole is a serotonin-dopamine activity modulator with a distinct receptor binding profile.
  • Previous treatments may yield incomplete responses, necessitating novel therapeutic strategies.

Purpose of the Study:

  • To evaluate the efficacy and tolerability of adjunctive brexpiprazole in adults with MDD and an inadequate response to antidepressant treatment (ADT).

Main Methods:

  • Two Phase III randomized, double-blind, placebo-controlled trials were conducted.
  • Adult patients with MDD received either ADT monotherapy or ADT plus oral brexpiprazole (2 mg or 3 mg daily).
  • Symptom improvement was assessed using standardized depression rating scales over a defined treatment period.

Main Results:

  • Adjunctive brexpiprazole demonstrated statistically significant improvements in depressive symptoms compared to ADT monotherapy.
  • The drug was generally well tolerated across the study populations, with treatment durations up to 52 weeks.
  • Low intrinsic D2 activity suggests a potentially favorable side effect profile regarding activation-like adverse events.

Conclusions:

  • Adjunctive brexpiprazole is an effective and well-tolerated treatment option for adults with MDD experiencing persistent symptoms despite ADT.
  • Brexpiprazole provides a valuable addition to the therapeutic armamentarium for managing treatment-resistant depression.
  • Further research will elucidate brexpiprazole's long-term positioning in MDD treatment guidelines.