Brexpiprazole is a new atypical antipsychotic used for the management of psychiatric conditions including schizophrenia and is associated with fewer extrapyramidal side effects compared to traditional antipsychotics due to its additional serotonergic effect, which may improve cognitive symptoms associated with social function decline in schizophrenia. We searched for randomized controlled-trials (RCT) to review the efficacy and tolerability of brexpiprazole in acute management of schizophrenia using different resources including PubMed, Google Scholar, ClinicalTrials.gov and Cochrane Central Register of Controlled-Trials. Data were extracted for adverse effects, positive and negative syndrome scale (PANSS), Personal and Social Performance scale (PSP), PANSS Excited Component (PEC) and Response Rate >30%. 5 RCT were identified and showed that brexpiprazole was favorable compared to placebo in improving PANSS with a mean difference (MD) -5.40 [confidence interval (CI) -6.98, -3.82] and PSP 3.2 [CI 2.09, 4.32] (P<0.00001). Improvement in PANSS positive, PANSS negative subscales and response rate were significant (P<0.00001). Brexpiprazole led to reduced treatment discontinuation due to adverse effects (risk ratio (RR) 0.58), however an increased risk of akathisia was observed (RR= 1.31) especially at higher doses but did not reach statistical significance. In summary, brexpiprazole improved significantly the symptoms of schizophrenia and is well-tolerated, while long-term research is still required to establish its role, particularly in patients with co-morbidities. These findings will guide clinical teams in supporting patients suffering from schizophrenia.
