psychopharmacology-cme-horizontal

Lurasidone Indications: FDA-Approved Uses

Source: Drug labeling information submitted to the Food and Drug Administration (FDA), updated by the National Library of Medicine (NLM).

Lurasidone is a second generation antipsychotic approved for the treatment of schizophrenia and depressive episodes associated with bipolar disorder.

The table below shows recommended dosing for each indication:

IndicationStarting DoseRecommended Dose
Schizophrenia40 mg per day40 mg to 160 mg per day
Bipolar Disorder
Bipolar Depression20 mg per day20 mg to 120 mg per day

Clinical Trials

Efficacy for the Treatment of Schizophrenia

The efficacy of LATUDA for the treatment of schizophrenia was established in five short-term (6-week), placebo-controlled studies in adult patients (mean age of 38.4 years, range 18-72) who met DSM-IV criteria for schizophrenia. An active-control arm (olanzapine or quetiapine extended-release) was included in two studies to assess assay sensitivity.

Several instruments were used for assessing psychiatric signs and symptoms in these studies:

  1. Positive and Negative Syndrome Scale (PANSS), is a multi-item inventory of general psychopathology used to evaluate the effects of drug treatment in schizophrenia. PANSS total scores may range from 30 to 210.
  2. Brief Psychiatric Rating Scale derived (BPRSd), derived from the PANSS, is a multi-item inventory primarily focusing on positive symptoms of schizophrenia, whereas the PANSS includes a wider range of positive, negative and other symptoms of schizophrenia. The BPRSd consists of 18 items rated on a scale of 1 (not present) to 7 (severe). BPRSd scores may range from 18 to 126.
  3. The Clinical Global Impression severity scale (CGI-S) is a clinician-rated scale that measures the subject’s current illness state on a 1- to 7-point scale.

The endpoint associated with each instrument is change from baseline in the total score to the end of week 6. These changes are then compared to placebo changes for the drug and control groups.

The results of the studies follow:

  1. Study 1: In a 6-week, placebo-controlled trial (N=145) involving two fixed doses of LATUDA (40 or 120 mg/day), both doses of LATUDA at Endpoint were superior to placebo on the BPRSd total score, and the CGI-S.
  2. Study 2: In a 6-week, placebo-controlled trial (N=180) involving a fixed dose of LATUDA (80 mg/day), LATUDA at Endpoint was superior to placebo on the BPRSd total score, and the CGI-S.
  3. Study 3: In a 6-week, placebo- and active-controlled trial (N=473) involving two fixed doses of LATUDA (40 or 120 mg/day) and an active control (olanzapine), both LATUDA doses and the active control at Endpoint were superior to placebo on the PANSS total score, and the CGI-S.
  4. Study 4: In a 6-week, placebo-controlled trial (N=489) involving three fixed doses of LATUDA (40, 80 or 120 mg/day), only the 80 mg/day dose of LATUDA at Endpoint was superior to placebo on the PANSS total score, and the CGI-S.
  5. Study 5: In a 6-week, placebo- and active-controlled trial (N=482) involving two fixed doses of LATUDA (80 or 160 mg/day) and an active control (quetiapine extended-release), both LATUDA doses and the active control at Endpoint were superior to placebo on the PANSS total score, and the CGI-S.

Thus, the efficacy of LATUDA at doses of 40, 80, 120 and 160 mg/day has been established (Table 24).

Table 24: Primary Efficacy Results for Studies in Schizophrenia (BPRSd or PANSS Scores)
SD: standard deviation; SE: standard error; LS Mean: least-squares mean; CI: confidence interval, unadjusted for multiple comparisons.
a Difference (drug minus placebo) in least-squares mean change from baseline.
b Included for assay sensitivity.
* Doses statistically significantly superior to placebo.
StudyTreatment GroupPrimary Efficacy Measure: BPRSd
Mean Baseline Score (SD)LS Mean Change from Baseline (SE)Placebo-subtracted Differencea(95% CI)
1LATUDA (40 mg/day)*54.2 (8.8)-9.4 (1.6)-5.6 (-9.8, -1.4)
LATUDA (120 mg/day)*52.7 (7.6)-11.0 (1.6)-6.7 (-11.0, -2.5)
Placebo54.7 (8.1)-3.8 (1.6)
2LATUDA (80 mg/day)*55.1 (6.0)-8.9 (1.3)-4.7 (-8.3, -1.1)
Placebo56.1 (6.8)-4.2 (1.4)
Primary Efficacy Measure: PANSS
3LATUDA (40 mg/day)*96.6 (10.7)-25.7 (2.0)-9.7 (-15.3, -4.1)
LATUDA (120 mg/day)*97.9 (11.3)-23.6 (2.1)-7.5 (-13.4, -1.7)
Olanzapine (15 mg/day)*b96.3 (12.2)-28.7 (1.9)-12.6 (-18.2, -7.9)
Placebo95.8 (10.8)-16.0 (2.1)
4LATUDA (40 mg/day)96.5 (11.5)-19.2 (1.7)-2.1 (-7.0, 2.8)
LATUDA (80 mg/day)*96.0 (10.8)-23.4 (1.8)-6.4 (-11.3, -1.5)
LATUDA (120 mg/day)96.0 (9.7)-20.5 (1.8)-3.5 (-8.4, 1.4)
Placebo96.8 (11.1)-17.0 (1.8)
5LATUDA (80 mg/day)*97.7 (9.7)-22.2 (1.8)-11.9 (-16.9, -6.9)
LATUDA (160 mg/day)*97.5 (11.8)-26.5 (1.8)-16.2 (-21.2, -11.2)
Quetiapine Extended-release (600 mg/day)*b97.7 (10.2)-27.8 (1.8)-17.5 (-22.5, -12.4)
Placebo96.6 (10.2)-10.3 (1.8)

Examination of population subgroups based on age (there were few patients over 65), gender and race did not reveal any clear evidence of differential responsiveness.

Efficacy for Depressive Episodes Associated with Bipolar I Disorder

Monotherapy

The efficacy of LATUDA, as monotherapy, was established in a 6-week, multicenter, randomized, double-blind, placebo-controlled study of adult patients (mean age of 41.5 years, range 18 to 74) who met DSM-IV-TR criteria for major depressive episodes associated with bipolar I disorder, with or without rapid cycling, and without psychotic features (N=485). Patients were randomized to one of two flexible-dose ranges of LATUDA (20 to 60 mg/day, or 80 to 120 mg/day) or placebo.

The primary rating instrument used to assess depressive symptoms in this study was the Montgomery-Asberg Depression Rating Scale (MADRS), a 10-item clinician-rated scale with total scores ranging from 0 (no depressive features) to 60 (maximum score). The primary endpoint was the change from baseline in MADRS score at Week 6. The key secondary instrument was the Clinical Global Impression-Bipolar-Severity of Illness scale (CGI-BP-S), a clinician-rated scale that measures the subject’s current illness state on a 7-point scale, where a higher score is associated with greater illness severity.

For both dose groups, LATUDA was superior to placebo in reduction of MADRS and CGI-BP-S scores at Week 6. The primary efficacy results are provided in Table 25. The high dose range (80 to 120 mg per day) did not provide additional efficacy on average, compared to the low dose range (20 to 60 mg per day).

Adjunctive Therapy with Lithium or Valproate

The efficacy of LATUDA, as an adjunctive therapy with lithium or valproate, was established in a 6-week, multicenter, randomized, double-blind, placebo-controlled study of adult patients (mean age of 41.7 years, range 18 to 72) who met DSM-IV-TR criteria for major depressive episodes associated with bipolar I disorder, with or without rapid cycling, and without psychotic features (N=340). Patients who remained symptomatic after treatment with lithium or valproate were randomized to flexibly dosed LATUDA 20 to 120 mg/day or placebo.

The primary rating instrument used to assess depressive symptoms in this study was the MADRS. The primary endpoint was the change from baseline in MADRS score at Week 6. The key secondary instrument was the CGI-BP-S scale.

LATUDA was superior to placebo in reduction of MADRS and CGI-BP-S scores at Week 6, as an adjunctive therapy with lithium or valproate (Table 25).

Table 25: Primary Efficacy Results for Studies in Depressive Episodes Associated with Bipolar I Disorder (MADRS Scores)
SD: standard deviation; SE: standard error; LS Mean: least-squares mean; CI: confidence interval, unadjusted for multiple comparisons.
a Difference (drug minus placebo) in least-squares mean change from baseline. * Treatment group statistically significantly superior to placebo.
StudyTreatment GroupPrimary Efficacy Measure: MADRS
Mean Baseline Score (SD)LS Mean Change from Baseline (SE)Placebo-subtracted Differencea(95% CI)
Monotherapy studyLATUDA (20-60 mg/day)*30.3 (5.0)-15.4 (0.8)-4.6 (-6.9, -2.3)
LATUDA (80-120 mg/day)*30.6 (4.9)-15.4 (0.8)-4.6 (-6.9, -2.3)
Placebo30.5 (5.0)-10.7 (0.8)
Adjunctive Therapy studyLATUDA (20-120 mg/day)* + lithium or valproate30.6 (5.3)-17.1 (0.9)-3.6 (-6.0, -1.1)
Placebo + lithium or valproate30.8 (4.8)-13.5 (0.9)

Related lurasidone prescribing information

PDF: LAI Antipsychotics

Screenshot_2017-01-07_12.39.54

Free PDF Download

  • New formulations (Aristada, Invega Trinza)
  • Practical dosing tables
Powered by ConvertKit

Free Course: “SSRIs: The Essentials”

Fluoxetine

Learn the essentials of SSRIs with our free online course.

One module per week:

  • The Mechanism of Action of SSRIs
  • Fluoxetine
  • Fluvoxamine
  • Paroxetine
  • Sertraline
  • Citalopram and Escitalopram

Download All Videos and Earn CME Credits

Icons-01Premium members have access to these benefits:

  • Instant access to more than 40 exclusive video tutorials
  • Downloads for offline access (audio, video and PPT files)
  • Mobile access
  • Monthly updates
  • Instant access to 9 CME credits
  • Up to 21 CME credits a year

Learn more about premium membership

PDF: LAI Antipsychotics

Screenshot_2017-01-07_12.39.54

Free PDF Download

  • New formulations (Aristada, Invega Trinza)
  • Practical dosing tables
Powered by ConvertKit