A new type of schizophrenia medication promises fewer side effects

For the first time in decades, the Food and Drug Administration has approved a new type of medication for schizophrenia.

The twice-daily pill to be marketed by Bristol Myers Squibb will be called Cobenfy, although it was called KarXT during development. Its main advantage is that it appears to have fewer side effects than current medications.

This difference caught the attention of patients like Tiffany, a librarian in Oklahoma. She asked us to use only her first name due to the stigma associated with schizophrenia.

When she was first given antipsychotic medication, she said it made her feel like a zombie. Watching a video of her birthday party that year, she didn’t recognize herself.

“I was opening presents – everyone was happy. And I’m sitting there, like, there’s nothing happening. Like, I’m looking at a blank wall,” she says. “And then I lied and told everyone I was better.”

So she stopped taking the drug and basically stuck it out for years until she experienced another psychotic episode.

So she played what she calls the “medication game,” trying different pills until one worked for her. But some of the side effects were brutal. Common antipsychotic medications can cause weight gain and increase your risk of diabetes.

One of them caused Tiffany a movement disorder.

“So I was walking back and forth in my office eight hours a day, and it’s exactly 3 and a half steps, turn, 3 and a half steps, turn,” she says. “It was a nightmare.”

Decades of dopamine-focused drugs

Since the first antipsychotic medication was introduced in the 1950s, subsequent medications to treat psychosis work on the same chemical that helps the brain communicate with the rest of the body: dopamine.

“The dopamine hypothesis proposed that schizophrenia is associated with excessive dopamine neurotransmission – therefore, too much dopamine activity,” says Dr Ann Shinnpsychiatrist who directs clinical research on schizophrenia and bipolar disorder at McLean Hospital near Boston.

Dopamine is the neurotransmitter usually associated with reward and learning, but it actually has many functions. It also plays a role in controlling movement, for example – that’s why that drug made Tiffany walk.

The new drug targets different brain receptors

Cobenfy is the first new drug for psychosis that does not act on dopamine.

“I became really interested in schizophrenia and through this work I became really interested in the idea of ​​targeting muscarinic receptors because here was a serendipitous clinical finding that suggested potential efficacy, which is really hard to find in psychiatry,” says the drug’s lead inventor, Andrew Miller.

He’s talking about a 1997 study done on Alzheimer’s patients about a drug that was shelved despite reducing psychosis.

Muscarinic receptors got their name because they respond to muscarine, a chemical present in some mushrooms. The problem with developing a drug to activate them in the brain is that they can trigger receptors in the gastrointestinal tract. Patients could not tolerate this.

So Miller and his team decided to add a second drug — one already used for overactive bladder — to turn off the gastrointestinal receptors. The trick: this medicine can’t pass from the blood to the brain.

This means it turns off the body’s muscarinic receptors, but it doesn’t stop the first drug from doing its work in the brain.

“Basically, Karuna did a brilliant thing by putting everything together in a drug combination,” says Shinn.

She’s talking about Miller’s company, Karuna Therapeutics, which was acquired by pharmaceutical heavyweight Bristol Myers Squibb for US$14 billion earlier this year.

How much will it cost?

Bristol Myers Squibb says the drug will be available starting in October for $1,850 per month, which is in line with other treatments for schizophrenia. It’s unclear how easy it will be for patients to obtain insurance coverage for Cobenfy.

“If it’s like many other new drugs, insurance will generally require people to first try at least two generic drugs… before paying for them,” says Dr. Jacob Ballon, associate professor of psychiatry at Stanford University. .

Still, he has many patients — and their parents — who are excited about a potential new treatment option, he says. Ballon is working on an ongoing study into how Cobenfy fits with existing medications and whether they can be used together.

Although the new drug is not for everyone, it could help patients who have had problems with existing treatments.

The FDA based its approval on 5-week, double-blind, placebo-controlled studies. This means that some patients received Cobenfy and others received placebo, but neither the patients nor the doctors knew which was which until the end of the study. The study’s short duration has led some experts to point out that questions remain about the drug’s long-term safety and effectiveness.

Common side effects of Cobenfy include nausea, constipation, and rapid heartbeat.

As for Tiffany, she’s interested in trying the drug in the future. Unlike previous medications that only combat the so-called positive symptoms of schizophrenia, such as hallucinations and delusions, Cobenfy has been shown to decrease “negative” symptoms, such as apathy and lack of motivation.

“Every time I have an episode, I lose pieces of myself and functionality… and that’s not fair to my husband, and I hate that,” she says. “So if I could have something that would help me have a little more initiative, that would be wonderful.”

She also has some advice for people with schizophrenia who are still looking for the right treatment.

“Keep trying,” she says. “It’s really difficult to take and stop taking medication, but when you find the right medication, it makes a huge difference – night and day.”