Cariprazine in Youth with Bipolar and Psychotic Disorders: A Retrospective Chart Review

Abstract

Objective:

To examine the potential effectiveness and tolerability of cariprazine in pediatric bipolar and psychotic disorders.

Methods:

We retrospectively reviewed the electronic health records of patients <21 years of age prescribed cariprazine to treat bipolar and psychotic disorders. Adverse effects, tolerability, therapeutic response (Clinical Global Impression–Improvement [CGI-I]), and severity of illness (Clinical Global Impression–Severity [CGI-S]) were determined through manual chart review.

Results:

We identified 16 patients aged 6–20 years who were treated with cariprazine (initial dose: 1.5 mg/day, interquartile range [IQR], 1.5–1.5; endpoint dose: 3 mg/day, IQR, 1.5–4.5). No serious adverse events were reported, but the most commonly reported side effect was weight gain (n = 3, 19%). Of the 14 patients for whom baseline and endpoint body mass index (BMI) data were available, neither changes in BMI (p = 0.391; 0.54 kg/m², IQR, −0.33 to 1.38) nor BMI percentile (p = 0.71; 0.36%, IQR, −0.49 to 3.97) significantly differed between baseline and endpoint. However, patients receiving ≥4.5 mg/day had a significantly greater BMI increases during the course of treatment compared with those receiving ≤3 mg/day (p = 0.034; −1.14 kg/m², IQR, −3.65 to 0.53 vs. 1.01 kg/m², IQR, 0.17–4.88). CGI-S scores (p = 0.016; 4.5, IQR, 4–5 vs. 4, IQR, 3–4) significantly differed from baseline to endpoint. The response rate was 44% (n = 7/16), with responders being prescribed higher doses (p = 0.005; 6 mg/day, IQR, 4.875–6 vs. 3 mg/day, IQR, 3–4.125).

Conclusions:

Cariprazine may be well tolerated and effective for pediatric bipolar and psychotic disorders; however, compared with higher doses, total daily doses ≤3 mg/day appear to be more tolerable. Prospective controlled studies to further evaluate cariprazine in youth are needed.