An open-label, positron emission tomography study of the striatal D2/D3 receptor occupancy and pharmacokinetics of single-dose oral brexpiprazole in healthy participants

Dean F. Wong, Arash Raoufinia, Patricia Bricmont, James R. Brašić, Robert D. McQuade, Robert A. Forbes, Tetsuro Kikuchi, Hiroto Kuwabara

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: The aim of this Phase 1, open-label, positron emission tomography (PET) study was to determine the degree of striatal D2/D3 receptor occupancy induced by the serotonin–dopamine activity modulator, brexpiprazole, at different single dose levels in the range 0.25–6 mg. Methods: Occupancy was measured at 4 and 23.5 h post-dose using the D2/D3 receptor antagonist [11C]raclopride. The pharmacokinetics, safety and tolerability of brexpiprazole were assessed in parallel. Results: Fifteen healthy participants were enrolled (mean age 33.9 years; 93.3% male). Mean D2/D3 receptor occupancy in the putamen and caudate nucleus increased with brexpiprazole dose, leveled out at 77–88% with brexpiprazole 5 mg and 6 mg at 4 h post-dose, and remained at a similar level at 23.5 h post-dose (74–83%). Estimates of maximum obtainable receptor occupancy (Omax) were 89.2% for the putamen and 95.4% for the caudate nucleus; plasma concentrations predicted to provide 50% of Omax (EC50) were 8.13 ng/mL and 7.75 ng/mL, respectively. Brexpiprazole area under the concentration–time curve (AUC) and maximum plasma concentration (Cmax) increased approximately proportional to dose. No notable subjective or objective adverse effects were observed in this cohort. Conclusion: By extrapolating the observed single-dose D2/D3 receptor occupancy data in healthy participants, multiple doses of brexpiprazole 2 mg/day and above are expected to result in an efficacious brexpiprazole concentration, consistent with clinically active doses in schizophrenia and major depressive disorder. Trial registration: ClinicalTrials.gov NCT00805454 December 9, 2008.

Original languageEnglish (US)
JournalEuropean journal of clinical pharmacology
DOIs
StateAccepted/In press - 2020

Keywords

  • Antipsychotic agents
  • Brexpiprazole
  • Dopamine receptors
  • Dose determination
  • Positron-emission tomography
  • Raclopride
  • Receptor occupancy
  • Target engagement

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

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