(353) Real world assessment of manic events among patients with bipolar I disorder treated with cariprazine versus other atypical antipsychotics

Background: : Antipsychotics, including atypical antipsychotics (AAs), are first-line treatment for bipolar I disorder (BP-I). Cariprazine is a dopamine D3 preferring D3/D2 and serotonin 5-HT1A receptor partial agonist AA approved in USA for treating BP-I manic/mixed and depressive episodes. Data on cariprazine’s real-world effectiveness compared to other commonly used agents is limited.

Objective: : Compare rates of BP-I manic events in patients treated with cariprazine versus quetiapine and lurasidone.

Methods: : A retrospective observational study using claims data(IQVIA PharMetrics® Plus database;September 2014-2022) included adults with BP-I and ≥2 AA pharmacy claims for cariprazine, quetiapine or lurasidone. Index date was the first claim. The baseline period was the 12 months before index date.The follow-up period (≥3 months) spanned from the index date to the earliest of the following: discontinuation of the index AA, exposure to a different AA or a long-acting injectable antipsychotic, schizophrenia diagnosis, or end of data availability or eligibility. Inverse probability of treatment weighting balanced differences in baseline patient characteristics. Manic events were identified using a claims algorithm. Rates of manic events per patient-year (PPY) were compared between weighted cohorts for cariprazine vs comparators. Rate ratios (RRs) from Poisson regression models were calculated for each pairwise comparison, with 95% CIs and P values from nonparametric bootstrapping.

Results: : Manic events between cariprazine (n=4,125) vs quetiapine (n=12,177), weighted cohorts were well-balanced across baseline characteristics, including mean age (39.1 vs 39.3 years) and sex (64.9% vs 63.2% female). For cariprazine (n=4,440) vs lurasidone (n=8,134), weighted cohorts, the characteristics were also balanced, including mean age (38.9 vs 38.8 years) and sex (70.3% vs 70.4% female). Cariprazine use had lower rates of manic events PPY compared with quetiapine (RR[95% CI]=0.57[0.44, 0.74], P <.001), due to lower rates of inpatient (IP)-defined manic events (RR=0.49[0.30, 0.73], P<.001) and outpatient (OP)-defined manic events (RR=0.57[0.43, 0.75], P<.001). Cariprazine use also had fewer manic events PPY versus lurasidone (RR=0.71[0.55, 0.93], P<.05), due to fewer IP-defined events (RR=0.64[0.45, 0.87], P<.01) and OP-defined events (RR=0.71[0.53, 0.96], P<.05). Emergency room manic event rates did not differ significantly between cariprazine and comparators.

Conclusions: : Cariprazine was associated with significantly lower rates of overall, IP, and OP manic events compared to quetiapine or lurasidone

Sponsorship:: AbbVie