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Psych Congress  

Comparative Efficacy and Cardiometabolic Profile of Antipsychotic Monotherapy for the Treatment of Bipolar Depression: A Network Meta-Analysis

Daisy Ng-Mak, PhD
Krithika Rajagopalan, PhD
Euan McLeod, MPharm, MSc
Ashley Pitcher, DPhil
Max Schlueter, MSc
Andrei Pikalov, MD
Antony Loebel, MD
Sunovion Pharmaceuticals Inc.

Background: Lurasidone is an atypical antipsychotic indicated for patients with bipolar depression. The efficacy and safety of lurasidone monotherapy was established in a randomized controlled trial (RCT) using 20-60mg/day, 80-120mg/day, or placebo in patients with bipolar I depression. In the absence of head-to-head trial data, this network meta-analysis indirectly compared the efficacy and cardiometabolic profile of lurasidone with quetiapine.

Methods: Systematic literature review identified 6 RCTs (1 for lurasidone and 5 for quetiapine), which were compared using a Bayesian network meta-analysis. Efficacy outcomes included were remission (change in endpoint score of ≤12 on the Montgomery-Åsberg Depression Rating Scale [MADRS]) and response (≥50% reduction in MADRS from baseline). Cardiometabolic profile was evaluated by mean changes in: weight, HbA1c, triglycerides, high-density lipoprotein (HDL), and total cholesterol (TC). Odds ratios (ORs) were calculated for efficacy outcomes and mean differences were calculated for cardiometabolic outcomes, both with associated 95% credible intervals (CrI).

Results: Using a random-effects model, lurasidone (20-120mg/day) was associated with comparable ORs for remission relative to all treatments: quetiapine 300mg/day (1.10,CrI 0.63-1.90), quetiapine 600mg/day (1.03,CrI 0.59-1.79), and quetiapineXR 300mg/day (1.16,CrI 0.55-2.42). Results for response were consistent with these findings. Relative mean changes in cardiometabolic parameters were generally more favorable for lurasidone than quetiapine with respect to weight (-1.17kg to -0.63kg), HbA1c (-0.03% to -0.01%), triglycerides (-14.28mg/dL to -5.34mg/dL), HDL (0.70mg/dL to 1.89mg/dL), and TC (0.18mg/dL to 3.85mg/dL).

Conclusion: Indirect evidence from this network meta-analysis suggests that lurasidone has comparable efficacy with a favorable cardiometabolic profile in patients with bipolar depression versus quetiapine.

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