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D2 receptor occupancy following lurasidone treatment in patients with schizophrenia or schizoaffective disorder

Published online by Cambridge University Press:  30 September 2013

Steven G. Potkin ,
David B. Keator ,
Marilyn L. Kesler-West ,
Dana D. Nguyen ,
Theo. G. M. van Erp ,
Jogeshwar Mukherjee ,
Nikunj Shah  and
Adrian Preda
Steven G. Potkin*
Affiliation:
University of California–Irvine, School of Medicine, Irvine, California, USA
David B. Keator
Affiliation:
University of California–Irvine, School of Medicine, Irvine, California, USA
Marilyn L. Kesler-West
Affiliation:
University of California–Irvine, School of Medicine, Irvine, California, USA
Dana D. Nguyen
Affiliation:
University of California–Irvine, School of Medicine, Irvine, California, USA
Theo. G. M. van Erp
Affiliation:
University of California–Irvine, School of Medicine, Irvine, California, USA
Jogeshwar Mukherjee
Affiliation:
University of California–Irvine, School of Medicine, Irvine, California, USA
Nikunj Shah
Affiliation:
University of California–Irvine, School of Medicine, Irvine, California, USA
Adrian Preda
Affiliation:
University of California–Irvine, School of Medicine, Irvine, California, USA
*
*Address for correspondence: Steven G. Potkin, MD, Professor of Psychiatry and Human Behavior, Robert R. Sprague Chair in Brain Imaging, University of California–Irvine, 5251 California Avenue, Suite 240, Irvine, CA 92617, USA. (Email sgpotkin@uci.edu)
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Abstract

Objective/Introduction

Lurasidone is an atypical antipsychotic medication approved for the treatment of schizophrenia over a dose range of 40–160 mg/day. This study examined D2 receptor occupancy and its association with clinical improvement and side effects in patients with schizophrenia or schizoaffective disorder following repeated doses of 80, 120, or 160 mg/day of lurasidone.

Methods

Twenty-five patients with The Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) diagnoses of schizophrenia or schizoaffective disorder were washed out of their antipsychotic medications (5 half-lives) and randomly assigned to 80, 120, or 160 mg/day of lurasidone. Subjects were imaged with 18F-fallypride at baseline and at steady-state lurasidone treatment to determine D2 receptor occupancy.

Results

Blood lurasidone concentration (plus major metabolite), but not dose, significantly correlated with D2 receptor occupancy. D2 receptor occupancy in several subcortical structures is associated with positive but not negative symptom improvement or the presence of movement symptoms.

Discussion

Blood concentrations greater than 70 ng/mL may be required to achieve a 65% occupancy level in subcortical areas. Intersubject blood concentrations at fixed dose were highly variable and may account for the lack of dose correlations.

Conclusions

Positron emission tomography (PET) occupancy data suggest that greater than 65% occupancy can be achieved across the dose range of 80–160 mg/day and that some patients require higher doses to achieve antipsychotic efficacy; this finding supports prior randomized clinical trial results.

Keywords

brain imagingD2 receptorLurasidoneOccupancyPETschizoaffectiveSchizophrenia
Type
Original Research
Information
CNS Spectrums , Volume 19 , Issue 2 , April 2014 , pp. 176 - 181
Copyright
Copyright © Cambridge University Press 2013 

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Footnotes

This investigator-initiated study was funded by Sunovion Pharmaceuticals.

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