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Reviewing Non-Dopaminergic Mechanisms for Positive and Negative Schizophrenia Symptom Management
Program Introduction
What is the future of schizophrenia treatment? An in-depth exploration of novel, non-dopaminergic therapies transforming the standard of care for patients with schizophrenia’s positive and negative symptoms.
Learning Objectives
After completing this educational activity, you should be able to:
- Outline current medication classes used in the treatment of schizophrenia
- Articulate side effect development and negative symptom control challenges associated with standard-of-care antipsychotics
- Review the latest research describing the biologic rationale of novel non-dopaminergic pathways in schizophrenia
- Analyze emerging clinical trial data for non-dopamine-targeting schizophrenia therapies
Target Audience
Psychiatrists, psychiatric NPs, and psychiatric PAs
Program Description
Join Leslie Citrome, MD, MPH, Jonathan Meyer, MD, and Bethany Yeiser, president of the CURESZ foundation, for an engaging discussion of emerging, non-dopaminergic therapies for individuals experiencing the positive and negative symptoms associated with schizophrenia. In a live lecture format, Dr. Citrome first examines the longstanding, unmet needs of patients of schizophrenia before providing an overview of the dopaminergic treatment paradigm that has dominated care for over seventy years. To reinforce the issues tied to the current standard of care, Bethany shares her challenges living with schizophrenia, which included a period of homelessness and constant changes in medication. Dr. Meyer then documents the history behind the development of alternative drugs with presynaptic, antipsychotic mechanisms, such as muscarinic agonists and TAAR1 agonists. The presentation closes with an assessment of phase 2 clinical trial data supporting the use of xanomeline-trospium and ulotaront in patients with schizophrenia and speculation regarding their positioning in treatment algorithms.
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Support Statement
Supported by an educational grant from Sunovion Pharmaceuticals Inc. and Otsuka America Pharmaceutical, Inc.
Learning Objective
After completing this educational activity, you should be able to:
- Outline current medication classes used in the treatment of schizophrenia
- Articulate side effect development and negative symptom control challenges associated with standard-of-care antipsychotics
- Review the latest research describing the biologic rationale of novel non-dopaminergic pathways in schizophrenia
- Analyze emerging clinical trial data for non-dopamine-targeting schizophrenia therapies
Release and Expiration Dates
This CME activity was published in August 2023 and is eligible for AMA PRA Category 1 Credit™ through August 31, 2024.
Statement of Need and Purpose
Negative symptom control is an ongoing challenge in schizophrenia management. Ultimately, limitations in the management of schizophrenia partially originates from an incomplete understanding of complex and multifaceted aspects of schizophrenia pathophysiology. Currently available therapies such as the typical and atypical antipsychotics target dopaminergic pathways, including D1 and D2 receptor subtypes. Although successful in controlling positive symptoms of disease, anti-dopaminergic therapies offer less control of negative symptoms and cognitive symptoms of disease. Simultaneously, bothersome adverse events, such as weight gain and extrapyramidal symptoms may limit long-term therapeutic adherence.
Given the focus of therapeutics developed to date primarily on dopaminergic pathways involved in the schizophrenia disease process, appreciating potential novel pathways may offer hope to patients and spur participation in clinical trials for patients seeking improved therapeutic results.
Unlabeled and Investigational Usage
The faculty of this educational activity may include discussions of products or devices that are not currently labeled for use by the FDA. Faculty members have been advised to disclose to the audience any reference to an unlabeled or investigational use.
No endorsement of unapproved products or uses is made or implied by coverage of these products or uses.
Please refer to the official prescribing information for each product for discussion of approved indicators, contraindications and warnings.
Review Process
The faculty members agreed to provide a balanced and evidence-based presentation and discussed the topics and CME objectives during the planning sessions. The faculty’s submitted content was validated by CME Institute staff, and the activity was evaluated for accuracy, use of evidence, and fair balance by the Chair and a peer reviewer who is without conflict of interest.
The opinions expressed herein are those of the faculty and do not necessarily reflect the opinions of the CME provider and publisher or the commercial supporter
© Copyright 2023 Physicians Postgraduate Press, Inc.
Faculty Affiliation
Leslie Citrome, MD, MPH |
Jonathan M. Meyer, MD |
Financial Disclosure
The CME Institute adheres to the Standards for Integrity and Independence in Accredited Continuing Education of the Accreditation Council for Continuing Medical Education (ACCME). Any individuals in a position to control the content of a continuing education activity, including faculty, content developers, reviewers, staff, and others, are required to disclose to learners the presence or absence of any relevant financial relationships with an ACCME-defined ineligible company within the preceding 24 months of the activity. The ACCME defines an “ineligible company” as one whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
The CME Institute has mitigated all relevant conflicts of interest prior to the commencement of the activity. None of the individuals involved in the content have relevant financial relationships with ineligible companies except the following:
Dr Meyer has received honoraria for speaking and teaching from Alkermes, Axsome, ITCI, Neurocrine, Noven, Sunovion, and Teva; and has received advisory board fees from Alkermes, Bioexcel, Cerevel, ITCI, Karuna, Neurocrine, Otsuka America, Inc., Relmada, Sunovion, and Teva.
Dr Citrome has received consulting fees from AbbVie/Allergan, Acadia, Adamas, Alkermes, Angelini, Astellas, Avanir, Axsome, BioXcel, Boehringer Ingelheim, Cadent Therapeutics, Cerevel, Clinilabs, COMPASS, Eisai, Enteris BioPharma, HLS Therapeutics, Idorsia, INmune Bio, Impel, Intra-Cellular Therapies, Janssen, Karuna, Lundbeck, Lyndra, Medavante-ProPhase, Marvin, Merck, Mitsubishi-Tanabe Pharma, Neurocrine, Neurelis, Novartis, Noven, Otsuka, Ovid, Praxis, Recordati, Relmada, Reviva, Sage, Sunovion, Supernus, Teva, University of Arizona, Vanda, and one-off ad hoc consulting for individuals/entities conducting marketing, commercial, or scientific scoping research; has received honoraria for speaking and teaching from AbbVie/Allergan, Acadia, Alkermes, Angelini, Axsome, BioXcel, Eisai, Idorsia, Intra-Cellular Therapies, Janssen, Lundbeck, Neurocrine, Noven, Otsuka, Recordati, Sage, Sunovion, Takeda, Teva, and CME activities organized by medical education companies such as Medscape, NACCME, NEI, Vindico, and Universities and Professional Organizations/Societies; is a stock shareholder of Bristol-Myers Squibb, Eli Lilly, J & J, Merck, Pfizer purchased > 10 years ago; has stock options with Reviva; and has received royalties/publishing Income from Taylor & Francis (Editor-in-Chief, Current Medical Research and Opinion, 2022-date), Wiley (Editor-in-Chief, International Journal of Clinical Practice, through end 2019), UpToDate (reviewer), Springer Healthcare (book), and Elsevier (Topic Editor, Psychiatry, Clinical Therapeutics).
Bethany Yeiser has received consulting fees from Alkermes; received grant/research support from Karuna Therapeutics, Janssen; and has received honoraria for speaking/teaching from Teva, Neurocrine Biosciences, and Psych Congress.
None of the other faculty, planners, reviewers, and CME Institute staff for this educational activity have relevant financial relationships with ineligible companies to disclose. All relevant financial relationships have been mitigated.
Accreditation Statement
The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit Designation
The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.
To obtain credit for this activity, study the material and complete the CME Posttest and Evaluation.
Available Credit
- 1.00 AMA PRA Category 1 Credit™
- 1.00 Participation