Real-World Assessment of Healthcare Resource Utilization-Defined Manic and Depressive Events Among Patients with Bipolar I Disorder Treated with Cariprazine Versus Aripiprazole

Atypical antipsychotics (AAs) are first-line treatments for bipolar I disorder (BP-I). While cariprazine is approved in the US for the treatment of both BP-I manic/mixed and depressive episodes, most other AAs are only approved for one affective pole but are utilized across the disease spectrum. For example, aripiprazole is only approved for BP-I manic/mixed episodes. This real-world analysis compared the rates of healthcare resource utilization (HRU)-defined manic and depressive events among patients treated with cariprazine versus aripiprazole. A retrospective observational cohort study was conducted using IQVIA® PharMetrics® Plus Database (5/28/2018–6/30/2022). Adults diagnosed with BP-I with ≥ 2 dispensings for cariprazine or aripiprazole were included. Cohorts were balanced via inverse probability of treatment weighting. Manic and depressive events were identified using a claims-based algorithm and reported per person-year (PPY) by setting of care [inpatient, emergency department (ED), and outpatient] and overall (any setting). Manic and depressive events during the ≥ 3-month on-treatment period were compared between cohorts via rate ratios (RRs) with P values and 95% CIs generated using nonparametric bootstrap procedures. The cariprazine cohort included 2530 patients with 604 manic and 884 depressive overall events, while the aripiprazole cohort included 7057 patients with 2301 manic and 2958 depressive overall events. The overall rate of HRU-defined manic events PPY was 37% lower in the cariprazine versus aripiprazole cohort [RR (95% CI): 0.63 (0.43, 0.94); P < .05]. Rates of outpatient-defined manic events were also significantly lower for cariprazine versus aripiprazole [0.62 (0.39, 0.94); P < .05], whereas inpatient and ED-defined manic events were similar. The overall rate of HRU-defined depressive events PPY was 28% lower for cariprazine than aripiprazole [0.72 (0.59, 0.90); P < .001], which was driven by the significantly lower rate of outpatient-defined events for cariprazine [0.72 (0.58, 0.89); P < .001]; inpatient- and ED-defined events were similar. In this real-world analysis, overall rates of HRU-defined manic and depressive events were significantly lower for cariprazine versus aripiprazole, demonstrating the relative real-world value of cariprazine versus aripiprazole, and underscoring the potential HRU benefits of cariprazine’s full-spectrum efficacy. Bipolar I disorder involves mood swings between mania, or abnormally elevated and extreme mood, and depression. Most bipolar medications only treat one type of these symptoms. For example, aripiprazole is a bipolar medication that is only approved to treat bipolar I mania. Cariprazine, on the other hand, is a medication approved to treat both bipolar I mania and depression. It is not known how cariprazine affects mania and depression symptoms in the real world relative to drugs that only treat one type of bipolar I disorder symptom, like aripiprazole. Therefore, we used health insurance records to look at how often patients treated with cariprazine or aripiprazole had manic or depressive events based on their healthcare resource use. Our results showed that patients using cariprazine had fewer overall events of mania or depression compared with patients using aripiprazole. Rates of manic and depressive events based on outpatient settings, such as a doctor’s office, were also lower with cariprazine versus aripiprazole. However, rates of manic and depressive events based on hospital or emergency room visits were similar between the two groups. These results suggest that using a medication like cariprazine that has been shown to work across mania and depression may have real-world benefits for patients with bipolar I disorder.