New medications for schizophrenia are rare, But treatments have been around since the 1950s. Those affected suffer from very different symptoms, which makes treatment complicated. The side effects of the medications used can also complicate the treatment of schizophrenia.
The new drug contains a combination of two active ingredients. One works against the symptoms of schizophrenia, the other is an old friend.
New drug effective against schizophrenia
Xanomeline is the name of the active ingredient that works against schizophrenia in the new drug. It penetrates the blood-brain barrier and acts as an agonist Muscarinic receptors the types M1 and M4. These acetylcholine receptors are found in certain areas of the brain and play a role in the development of psychoses such as schizophrenia.
Since muscarinic receptors are also found in the periphery, xanomeline alone would also activate these and thus lead to side effects. That’s why the centrally active xanomeline is combined with trospium chloride in the new drug. This has no significance in schizophrenia. Because the well-known substance only has an antagonistic effect on peripheral muscarinic receptors, it prevents side effects. That is permitted Anticholinergikum with excessive urge to urinate.
In clinical studies, the new drug Cobenfy® shows good effectiveness against the symptoms of schizophrenia within five weeks. Long-term data over one year have not yet been published, but appear to have been available to the American FDA.
“Breakthrough” in the treatment of schizophrenia
The new drug is used to treat schizophrenia and is taken twice daily, at least one hour before or two hours after meals. The most common side effects are nausea, indigestion, increased blood pressure and pulse, and dizziness. Angioedema or urinary retention may also occur. If angle-closure glaucoma or liver or kidney dysfunction are known, treatment with the new drug for schizophrenia should be undertaken with caution.
In Europe, the authorities have not yet received an application for approval for Cobenfy®. In this country, experts rate the new drug as a “breakthrough in the pharmacotherapy of schizophrenia”. Professor Dr. Alkomiet Hasan, chair of psychiatry and psychotherapy at the University of Augsburg, sees particular potential in the new drug in acute psychoses, which also includes schizophreniaand in early phases of the disease.
Causes of schizophrenia largely unknown
Schizophrenia is a heterogeneous disease, which makes treatment difficult. There have been no new medications for decades. The symptoms of schizophrenia are divided into positive and negative symptoms. Positive symptoms are based on increased psychological activity and are expressed in hallucinations and delusions. Negative symptoms caused by reduced psychological activity are restrictions on thinking, feeling and acting.
The usual treatment for schizophrenia is with neuroleptics. These substances act on different receptors; the exact mechanisms of action are not known. The first substance was cloprothixene, the most commonly used active ingredient worldwide is haloperidol. The new drug offers a completely new approach to schizophrenia for the first time.
The cause of schizophrenia is thought to be a multifactorial process consisting of changes in brain anatomy and psychosocial factors. Early childhood infections are also discussed as causes of schizophrenia Herpes– or influenza viruses, drug use or Lyme disease. Around 0.5 to 1 percent of Germans suffer from schizophrenia. New medications are urgently needed because around ten percent of those affected by schizophrenia ultimately take their own lives.
In Professor Hasan’s eyes, the new drug has particular potential against the positive symptoms of schizophrenia. It has little sedating effect and, in contrast to conventional treatments, poses little risk of motor side effects. Comparative studies will have to clarify whether the new drug can also alleviate the negative symptoms of schizophrenia and whether it works as well as previous treatments.
Sources:
https://www.pharmazeutische-zeitung.de/neues-wirkprinzip-bei-schizophrenie-150264/
https://www.fda.gov/news-events/press-announcements/fda-approves-drug-new-mechanism-action-treatment-schizophrenia
https://flexikon.doccheck.com/de/Schizophrenie
