Experts Guide Aripiprazole Lauroxil Use for Tailored Schizophrenia Treatment

A poster recently presented at NEI Congress 2023 suggests the use of aripiprazole lauroxil (AL), a long-acting injectable (LAI) atypical antipsychotic for schizophrenia, as a versatile option supported by its pharmacokinetic, efficacy, and safety characteristics. Findings also suggested AL treatment regimen initiation with a NanoCrystal Dispersion formulation (AL_NCD) plus a single 30 mg oral dose of aripiprazole without supplemental oral doses can enhance flexibility in diverse clinical settings.

“When selecting antipsychotic treatments for schizophrenia, clinicians must consider the risks versus the benefits of available agents in combination with the patient’s specific values and preferences,” Leslie Citrome, MD, MDH; Christoph U. Correll, MD; Gregory W. Mattingly, MD; J. Andrew Cutler, MD; Amber R. Hoberg, NP, CRNP; and co-authors wrote in the poster.

AL's development incorporated proprietary prodrug technology, ensuring predictable dissolution after intramuscular injection. This resulted in a pharmacokinetic profile marked by a prolonged half-life with minimal variation in aripiprazole concentrations across the dosing interval.

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Aripiprazole lauroxil (AL) offers 5 different dosing plans, including the 3 different dosing intervals, providing personalized options for patients.

Clinicians can select an AL regimen to provide plasma aripiprazole exposure, ranging from lower to higher concentrations associated with efficacy. The 3 different intervals provide options for achieving effective intermediate-range aripiprazole concentrations. (1) Lower exposure: 441 mg monthly; (2) Higher exposure: 882 mg monthly and; (3) Intermediate exposure: 662 mg monthly, 882 mg every 6 weeks, 1064 mg every 2 months. 

The other 2 plans are (3) AL initiation can be tailored to different care settings, with options for a 1-day or a 21-day regimen, authors said; and (5) the prolonged-release characteristics of AL allow for dosing to be resumed after treatment gaps lasting up to 6-10 weeks, depending on the chosen regimen—no supplementation or reinitiation is needed during these breaks.

“For LAI antipsychotic choices, LAI pharmacokinetics (PK), site of administration, ease of use, and dosing interval are also considered, enabling tailored treatment approaches for individual patients,” authors concluded. 

Reference

Citrome L, Correll C, Mattingly G, Cutler A, et al. Key characteristics of the long-acting injectable antipsychotic aripiprazole lauroxil for the treatment of adults with schizophrenia. Poster presented at NEI congress; November 9-12, 2023; Colorado Springs, Colorado.