Cariprazine and cognition in patients with schizophrenia and bipolar disorder: A systematic review
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Background Cariprazine is a recently incorporated drug whose differential characteristic is its partial agonism for the D3 receptor, with great affinity for it, higher than dopamine itself. Preclinical studies with animal models have shown a manifest pro cognitive effect. The objective of this study is to conduct a systematic review examining the effects of cariprazine on cognitive measures in patients with schizophrenia and bipolar disorder. Methods Two independent reviewers searched PubMed, Web of Science, Scopus, and Cochrane Library databases to December 31st 2023 following the PRISM guideline. Additional studies were identified through hand-searching of references of the included studies. Eligible studies were those randomized controlled trials published in English evaluating the effects of the use of cariprazine on cognitive outcomes in patients with mental disorders. Quality assessment followed the Jadad scale recommendations. Results From a total of 136 initial reports, up to 5 studies comprising 6104 patients with schizophrenia, bipolar I mania and bipolar I depression were included in the systematic review. In patients with schizophrenia, the use of cariprazine showed better cognitive outcomes compared to placebo in both early and late stages. Furthermore, cariprazine showed cognitive advantages over risperidone in patients with a predominance of negative symptoms and over aripiprazole when the variables power and continuity of attention were measured. In patients with bipolar disorder, cariprazine showed cognitive improvements compared to placebo. Most studies seem to find a greater pro cognitive effect with low doses of cariprazine (1.5-3 mg/d). Conclusions Overall, cariprazine improved cognitive measures compared to placebo, especially in patients with greater baseline impairment and when low doses are used. Thus, the use of cariprazine in patients with schizophrenia and bipolar disorder could become an effective therapeutic option to enhance cognition as well as other inherent symptoms of both disorders. Systematic review registration PROSPERO CRD42023485028.
