Lurasidone Initial Dosing Associated with Baseline Bipolar Diagnosis Categories and Antipsychotic Use: A Retrospective Claims Database Analysis

OBJECTIVE: Lurasidone is an approved treatment for bipolar depression in adults as monotherapy and adjunctive-therapy with mood stabilizers. This study aims to explore real-world initial dosage related to bipolar disorder (BD) diagnostic codes and prior second-generation antipsychotic (SGA) use in BD patients prescribed lurasidone.

METHODS: Using the LifeLink Pharmetrics-Plus database, adult BD patients initiating lurasidone between 11/01/2010-12/31/2012 with ≥6 months continuous enrollment before/after lurasidone initiation were grouped by starting daily lurasidone dose: 20, 40, 60-80, and 120-160mg (60-80 and 120-160 combined due to sample size). Baseline ICD-9 BP codes (depression, mania, mixed) and prior SGA use were compared across dose groups using Cochran-Armitage trend tests.

RESULTS: Of 1,119 patients initiating lurasidone (mean age 40.6 years; 70.7% female), 72.9% used other SGAs during 6 months prior to lurasidone (26.7% quetiapine, 21.2% aripiprazole, 14.4% ziprasidone were most frequent). Most patients initiated lurasidone on 40mg(62.1%) followed by 80mg(27.0%), 20mg(7.1%), 120-160mg(2.1%), and 60mg(1.2%). Mean daily dose was 51.9mg (SD 23.4) at initiation and 55.2 (SD 22.9) mg over 6-months post-initiation. Baseline diagnosis of bipolar mania(25.7% overall; 13.8%[20mg], 25.5%[40mg], 28.7%[60-80mg], 34.8%[120-160mg]) and mixed bipolar(32.3% overall; 27.5%[20mg], 30.9%[40mg], 35.2%[60-80mg], 47.8%[120-160mg]) were significantly associated with higher initial dose. A dose-trend association was also observed for bipolar depression(35.4% overall; 36.3%[20mg], 33.4%[40mg], 38.6%[60-80mg], 47.8%[120-160mg]; P=0.11). Prior SGAs use (any and quetiapine) was significantly associated with higher initial lurasidone dose.

CONCLUSIONS: Within this real-world analysis, three-fourths of BD patients prescribed lurasidone used other SGAs prior to lurasidone. Patients with bipolar mania, mixed bipolar, and prior antipsychotic use were more frequently prescribed higher starting lurasidone doses.