title: Lurasidone Dose Escalation in Early Nonresponding Patients With Schizophrenia: A Randomized, Placebo-Controlled Study.
abstract: OBJECTIVE
  To assess the effect of dose increase in adult patients with schizophrenia who demonstrate inadequate initial response to standard-dose lurasidone and to evaluate the efficacy of low-dose lurasidone in adult patients with schizophrenia.
  
  
  METHODS
  In this randomized, double-blind, placebo-controlled study conducted between May 2013 and June 2014, hospitalized patients with acute schizophrenia (DSM-IV-TR criteria) were randomly assigned to double-blind treatment with lurasidone 20 mg/d (n = 101), lurasidone 80 mg/d (n = 199), or placebo (n = 112). Nonresponders to lurasidone 80 mg/d (Positive and Negative Syndrome Scale [PANSS] score decrease < 20%) at 2 weeks were re-randomized to lurasidone 80 mg/d or 160 mg/d for the remaining 4 weeks of the study. The primary outcome measure was change from baseline to week 6 in PANSS total score.
  
  
  RESULTS
  In nonresponders to lurasidone 80 mg/d (n = 95), dose increase to 160 mg/d at week 2 significantly reduced PANSS total score at week 6 study endpoint compared with continuing 80 mg/d (-16.6 vs -8.9; P < .05 [effect size = 0.52]). While a comparable magnitude of improvement was observed in Clinical Global Impression-Severity (CGI-S) score from week 2 to week 6 endpoint for lurasidone 160 mg/d versus 80 mg/d (-1.0 vs -0.6; effect size = 0.44), the difference was not statistically significant (P = .052). Patients receiving lurasidone 20 mg/d did not demonstrate significant improvement compared with placebo at week 6 in PANSS total (-17.6 vs -14.5; P = .26) or CGI-S (-0.93 vs -0.73; P = .17) scores. Few dose-related adverse effects associated with lurasidone were observed.
  
  
  CONCLUSIONS
  In adult patients with schizophrenia demonstrating nonresponse to 2 weeks of treatment with lurasidone 80 mg/d, dose increase to 160 mg/d resulted in significant symptom improvement compared with continuing lurasidone 80 mg/d. Lurasidone 20 mg/d was not associated with significant improvement in psychotic symptoms in adult patients with schizophrenia.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT01821378.
authors.affiliation: Sunovion Pharmaceuticals Inc, One Bridge Plaza North, Ste 510, Fort Lee, NJ 07024. antony.loebel@sunovion.com.|Sunovion Pharmaceuticals Inc, Fort Lee, New Jersey, and Marlborough, Massachusetts, USA.
authors.forename: Antony
authors.initials: A
authors.lastname: Loebel
authors.affiliation: Sunovion Pharmaceuticals Inc, Fort Lee, New Jersey, and Marlborough, Massachusetts, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Silva
authors.affiliation: Sunovion Pharmaceuticals Inc, Fort Lee, New Jersey, and Marlborough, Massachusetts, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Goldman
authors.affiliation: Sunovion Pharmaceuticals Inc, Fort Lee, New Jersey, and Marlborough, Massachusetts, USA.
authors.forename: Kei
authors.initials: K
authors.lastname: Watabe
authors.affiliation: Sunovion Pharmaceuticals Inc, Fort Lee, New Jersey, and Marlborough, Massachusetts, USA.
authors.forename: Josephine
authors.initials: J
authors.lastname: Cucchiaro
authors.affiliation: Department of Psychiatry & Behavioral Sciences, New York Medical College, Valhalla, New York, USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Citrome
authors.affiliation: Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks; and Department of Psychiatry, Hofstra North Shore-Long Island Jewish School of Medicine, Hempstead, New York, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Kane
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D000069056:Lurasidone Hydrochloride / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012559:Schizophrenia / Q000188:drug therapy*
chemical_list: D014150:Antipsychotic Agents; D000069056:Lurasidone Hydrochloride