Objective: Patients with schizophrenia value improved life engagement, a term that describes positive health aspects across emotional, physical, social, and cognitive domains. This post hoc analysis of clinical trial data aimed to investigate the effect of brexpiprazole on patient life engagement in schizophrenia over the short and long term.
Methods: Data were pooled from three 6-week, randomized, double-blind, placebo-controlled clinical trials (ClinicalTrials.gov identifiers: NCT01396421, NCT01393613, NCT01810380; N = 1385) and two 52-week, open-label extension studies (NCT01397786, NCT01810783; N = 408) of brexpiprazole in adults with schizophrenia. Patient life engagement was measured using a subset of 14 Positive and Negative Syndrome Scale items (score range: 14 [best] to 98 [worst]) that has previously demonstrated content validity. Mean score changes and response rates (based on minimal clinically important difference estimates of ≥5 and ≥10 points) were calculated.
Results: Greater improvement in patient life engagement from baseline to Week 6 was observed for brexpiprazole 2-4 mg/day (least squares mean [standard error] change: -8.3 [0.3]; n = 868) versus placebo (-5.7 [0.4]; n = 517), with a least squares mean difference of -2.58 (95% confidence interval: -3.57 to -1.58; p < 0.001; Cohen's d effect size: 0.28). These improvements were maintained over 58 weeks on brexpiprazole 1-4 mg/day (n = 399). At Week 6, response rates among patients treated with brexpiprazole versus placebo were 71.6% versus 58.0% (≥5-point improvement; p < 0.001) and 43.5% versus 32.8% (≥10-point improvement; p < 0.001). At Week 58 (n = 179), response rates among patients treated with brexpiprazole were 90.5% (≥5-point improvement) and 78.2% (≥10-point improvement).
Conclusion: Beyond its efficacy on psychotic symptoms, brexpiprazole has the potential to improve patient life engagement - an important patient-centered outcome in schizophrenia.
Keywords: Antipsychotic; brexpiprazole; life engagement; patient-centered outcomes; schizophrenia.
Schizophrenia is a serious mental disorder in which people may hear, see, or believe things that do not exist. Most people with schizophrenia hope to become more engaged with life, as well as to improve their schizophrenia symptoms. Being engaged with life means feeling happy and hopeful, having energy and motivation, being interested and involved in activities, and being alert and thinking clearly. This study investigated if brexpiprazole, a medicine for schizophrenia and some other medical conditions, can help to improve patients’ engagement with life. The researchers looked at data from over a thousand people with schizophrenia across five previously completed clinical trials. To measure ‘patient life engagement’, the researchers used data from a questionnaire filled in by doctors during their meetings with the patients. The results showed that, on average, people taking brexpiprazole (rather than a ‘placebo’ tablet) became more engaged with life over the first 6 weeks of treatment. For some people who kept taking brexpiprazole, these improvements lasted for over a year. This means that brexpiprazole may help people with schizophrenia to become more engaged with life, as well as improving their schizophrenia symptoms.