Lurasidona para el tratamiento del trastorno bipolar: una revisión narrativa de alcance
Contenido principal del artículo
Resumen
El trastorno bipolar es una enfermedad mental que afecta a 40 millones de personas en el mundo y se asocia con una alta carga psicosocial, médica, financiera y riesgo de mortalidad. Su tratamiento es complejo, lo que ha impulsado la búsqueda de alternativas terapéuticas eficaces y bien toleradas como la lurasidona. Esta revisión de tema se hizo con el objetivo de proporcionar una síntesis de la evidencia más reciente sobre su uso en trastorno bipolar, y se logró mediante una búsqueda de información en PubMed. Los resultados evidencian que es eficaz en depresión bipolar, incluso en población pediátrica, con un perfil de seguridad favorable. Su papel en la manía y el mantenimiento sigue siendo controvertido y no está claramente respaldado por las guías. En la actualidad se recomienda para depresión bipolar aguda y, off-label, en mantenimiento de depresión y episodios mixtos.
Detalles del artículo
Referencias
1. Singh B, Swartz HA, Cuellar-Barboza AB, Schaffer A, Kato T, Dols A, et al. Bipolar disorder. Lancet. 2025;406(10506):963-978.
2. Scott MR, McClung CA. Bipolar Disorder. Curr Opin Neurobiol. 2023;83:102801.
3. Sajatovic M, Briggs F, Adeniyi C, Koopman J, Black J, Weise C, et al. Association between symptom severity and medication adherence in adults with bipolar disorder reporting adherence challenges. Psychopharmacol Bull. 2024;54(3):60-72.
4. Kato T. Bipolar Disorder: From pathophysiology to treatment. Juntendo Iji Zasshi. 2021;68(1):17-24.
5. Cotton SM, Jain V, Ratheesh A, Shelton C, Macneil C, Filia KM, et al. Views of international experts on challenges to early intervention for bipolar disorder. World Psychiatry. 2025;24(2):275-277.
6. Tarzian M, Soudan M, Alhajji M, Ndrio M, Fakoya AO. Lurasidone for treating schizophrenia and bipolar depression: A review of its efficacy. Cureus. 2023;15(4):e38071.
7. Lin YW, Chen YB, Hung KC, Liang CS, Tseng PT, Carvalho AF, et al. Efficacy and acceptability of lurasidone for bipolar depression: A systematic review and dose-response meta-analysis. BMJ Ment Health. 2024;27(1):e301165.
8. Aronica R, Pagani C, Favalli V, Brambilla P, Nosari G, Delvecchio G. Efficacy of lurasidone in adults with bipolar depression: A systematic review and meta-analysis of its impact on depressive symptoms and disability. J Affect Disord. 2025;381:100-107.
9. Wang H, Xiao L, Wang HL, Wang GH. Efficacy and safety of lurasidone versus placebo as adjunctive to mood stabilizers in bipolar I depression: A meta-analysis. J Affect Disord. 2020;264:227-233.
10. Diao X, Luo D, Wang D, Lai J, Li Q, Zhang P, et al. Lurasidone versus quetiapine for cognitive impairments in young patients with bipolar depression: A randomized, controlled study. Pharmaceuticals (Basel). 2022;15(11):1403.
11. Niu X, Veeranki P, Dennen S, Dembek C, Laubmeier K, Liu Y, et al. Hospitalization risk among adults with bipolar I disorder treated with lurasidone versus other oral atypical antipsychotics: A retrospective analysis of Medicaid claims data. Curr Med Res Opin. 2021;37(5):839-846.
12. Kadakia A, Dembek C, Liu Y, Dieyi C, Williams GR. Hospitalization risk in pediatric patients with bipolar disorder treated with lurasidone vs. other oral atypical antipsychotics: A real-world retrospective claims database study. J Med Econ. 2021;24(1):1212-1220.
13. Koukopoulos A, Calderoni C, Kotzalidis GD, Callovini T, Moccia L, Montanari S, et al. Lurasidone for pediatric bipolar disorder: A systematic review. Pharmaceuticals (Basel). 2025;18(7):979.
14. Singh MK, Pikalov A, Siu C, Tocco M, Loebel A. Lurasidone in children and adolescents with bipolar depression presenting with mixed (subsyndromal hypomanic) features: Post hoc analysis of a randomized placebo-controlled trial. J Child Adolesc Psychopharmacol. 2020;30(10):590-598.
15. Singh MK, Siu C, Tocco M, Pikalov A, Loebel A. Sleep disturbance, irritability, and response to lurasidone treatment in children and adolescents with bipolar depression. Curr Neuropharmacol. 2023;21(6):1393-1404.
16. Nair SS, Chua CJM, Teo DCL. Lurasidone-induced manic switch in an adolescent with bipolar i disorder: A case report. East Asian Arch Psychiatry. 2021;31(3):81-83.
17. Li C, Yang L, Zhang Q, Zhang Y, Li R, Jia F, et al. Characterization of the molecular mechanisms underlying lurasidone-induced acute manic episodes in bipolar depression: A network pharmacology and molecular docking approach. CNS Neurosci Ther. 2025;31(4):e70383.
18. Khan N, Nasar A, Bajwa S, Jawad Butt A, Azher A, Mushtaq T, et al. TULIP study: Trail of lurasidone in bipolar disorder in Pakistan. Saudi J Biol Sci. 2021;28(1):1128-1132.
19. Higuchi T, Kato T, Miyajima M, Watabe K, Masuda T, Hagi K, Ishigooka J. Lurasidone in the long-term treatment of Japanese patients with bipolar I disorder: a 52 week open label study. Int J Bipolar Disord. 2021;9(1):25.
20. Nierenberg A, Lavin P, Javitt DC, Shelton R, Sapko MT, Mathew S, et al. NRX-101 (D-cycloserine plus lurasidone) vs. lurasidone for the maintenance of initial stabilization after ketamine in patients with severe bipolar depression with acute suicidal ideation and behavior: a randomized prospective phase 2 trial. Int J Bipolar Disord. 2023;11(1):28.
21. Dong Z, Grunebaum MF, Lan MJ, Wagner V, Choo TH, Milak MS, et al. Relationship of brain glutamate response to d-cycloserine and lurasidone to antidepressant response in bipolar depression: A pilot study. Front Psychiatry. 2021;12:653026.
22. Guillen-Burgos HF, Galvez-Florez JF, Moreno-López S, McIntyre RS. Lurasidone response in bipolar type I depression with childhood trauma exposure. Int J Neuropsychopharmacol. 2025;28(5):pyaf020.
23. Inoue T, Masuda T, Sano F, Maruyama H. Lurasidone for bipolar I depression with comorbid anxiety symptoms: Post hoc analysis of randomized, placebo-controlled studies. J Affect Disord. 2025;385:119348.
24. Goldberg JF, Siu C, Tocco M, Pikalov A, Loebel A. The effect of lurasidone on anxiety symptoms in patients with bipolar depression: A post hoc analysis. J Clin Psychiatry. 2023;84(4):22m14732.
25. Niu X, Dembek C, Fan Q, Mao Y, Divino V, Burch S, et al. The impact of lurasidone on functioning and indirect costs in adults with bipolar depression: a post hoc analysis. J Med Econ. 2022;25(1):152-159.
26. Huang H, Schmerold L, Dembek C, Fan Q, Dieyi C, Williams GR, et al Healthcare resource utilization, costs and treatment patterns in patients with bipolar disorder treated with lurasidone or cariprazine. J Med Econ. 2021;24(1):352-362.
27. Dembek C, Fan Q, Niu X, Mao Y, Anupindi VR, Laubmeier K, et al. Impact of lurasidone on health-related quality of life in adults with bipolar depression: a post hoc analysis. Curr Med Res Opin. 2022;38(9):1613-1619.
28. Kishi T, Sakuma K, Hamanaka S, Nishii Y, Iwata N. Discontinuation rate of lurasidone and quetiapine extended release in bipolar depression. Pharmacopsychiatry. 2024;57(5):245-248.
29. Kishi T, Yoshimura R, Sakuma K, Okuya M, Iwata N. Lurasidone, olanzapine, and quetiapine extended-release for bipolar depression: A systematic review and network meta-analysis of phase 3 trials in Japan. Neuropsychopharmacol Rep. 2020;40(4):417-422.
30. Tocco M, Newcomer JW, Mao Y, Pikalov A. Lurasidone and risk of metabolic syndrome: results from short and long-term studies in patients with bipolar depression. CNS Spectr. 2023;28(6):680-687.
31. Modugula H, Kumar A. Risk analysis of lurasidone in patients with schizophrenia and bipolar depression. CNS Neurol Disord Drug Targets. 2020;19(2):109-114.
32. Yang W, Hu D, Zheng B, Han B, Feng P, Zhou Y, et al. Rash caused by lurasidone in old chinese patient with bipolar disorder: case-based review. BMC Psychiatry. 2024;24(1):491.
33. Li ST, Yeh YW. Low-dose lurasidone-induced polydipsia complicated by hyponatremia in a patient with bipolar disorder. Clin Neuropharmacol. 2021;44(6):243-244.
34. Sakhardande KA, Sharma LP, Arumugham SS. Pseudothrombocytopenia in a patient with bipolar type 2 disorder on lurasidone: A case report. Indian J Psychiatry. 2022;64(1):109-110.
35. Kuang Q, Zhou S, She S, Zheng Y. A case report of sinus bradycardia after the addition of lurasidone in a patient with bipolar disorder. Clin Psychopharmacol Neurosci. 2023;21(2):395-399.
36. Jena M, Mishra A, Mishra BR, Nath S, Maiti R. Effect of lurasidone versus olanzapine on cardiometabolic parameters in unmedicated patients with schizophrenia: A randomized controlled trial. Psychopharmacology (Berl). 2020;237(11):3471-3480.
37. Caffrey D, Sowden GL. A missed case of lurasidone induced laryngospasm: A case study and overview of extrapyramidal symptom identification and treatment. Int J Psychiatry Med. 2021;56(2):73-82.
38. Kirpekar VC, Faye AD, Bhave SH, Tadke R, Gawande S. Lurasidone-induced anemia: Is there a need for hematological monitoring? Indian J Pharmacol. 2019;51(4):276-278.
39. Rafi M, Goyal C, Reddy P, Reddy S. Lurasidone induced thrombocytopenia: Is it a signal of drug induced myelosuppression? Indian J Psychol Med. 2018;40(2):191-192.
40. Singh S, Ahmad H, John AP. Lurasidone associated neutropenia. Aust N Z J Psychiatry. 2017;51(10):1055.
41. Stroup TS, Gray N. Management of common adverse effects of antipsychotic medications. World Psychiatry. 2018;17(3):341-356.
42. Arikera S, Vangal K, Naik N. Atypical presentation of neuroleptic malignant syndrome associated with lurasidone: a case report. Indian J Mental Health. 2020;7(4):390-393.
43. Kato M, Masuda T, Sano F, Kato T. The efficacy and safety of lurasidone in bipolar I depression with and without rapid cycling: A pooled post hoc analysis of two randomized, placebo-controlled trials. J Affect Disord. 2023;337:150-158.
44. Siwek M, Gorostowicz A. Lurasidone in therapy of treatment-resistant ultra-rapid cycling bipolar disorder: Case report. Clin Psychopharmacol Neurosci. 2021;19(3):568-571.
45. Tocco M, Mao Y. Efficacy and safety of adding lurasidone to ongoing therapy with lithium or valproate for the treatment of an acute bipolar depressive episode: A post hoc analysis of 2 placebo-controlled trials. J Clin Psychopharmacol. 2024;44(4):345-352.
46. Montiel C, Newmark RL, Clark CT. Perinatal use of lurasidone for the treatment of bipolar disorder. Exp Clin Psychopharmacol. 2022(2):249-252.
47. Huang CY, Lin SK. Therapeutic drug monitoring of lurasidone in patients with schizophrenia or bipolar disorder: A preliminary study. Psychiatry Clin Neurosci. 2022;76(12):674-675.
48. Raison CL, Siu C, Pikalov A, Tocco M, Loebel A. C-reactive protein and response to lurasidone treatment in children and adolescents with bipolar I depression: Results from a placebo-controlled trial. Brain Behav Immun. 2020;84:269-274.
49. Kishi T, Nakamura H, Kato T, Iwata N. A diagnostic test to examine early improvement as a predictor of later response to lurasidone in bipolar depression. Neuropsychopharmacol Rep. 2023;43(1):137-140.
50. Pardhi VP, Flora S. Stable solid dispersion of lurasidone hydrochloride with augmented physicochemical properties for the treatment of schizophrenia and bipolar disorder. Biopharm Drug Dispos. 2020;41(8-9):334-351.
51. Tran K, Ford C. Lurasidone hydrochloride for bipolar disorder: A review of clinical effectiveness, cost-effectiveness, and guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2020.
52. Grunze H, Vieta E, Goodwin GM, Bowden C, Licht RW, Azorin JM, et al. The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Acute and long-term treatment of mixed states in bipolar disorder. World J Biol Psychiatry. 2018(1):2-58.
53. Takaesu Y, Takeshima M, Watanabe K. Effectiveness and tolerability of lurasidone for bipolar types I and II and other specified bipolar depression: A 12-week observational study. J Clin Psychopharmacol. 2022;42(5):485-488.
54. Horikoshi S, Suzuki Y, Kobayashi Y, Hirata Y, Ichinose M, Hoshino H, et al. Real-world effectiveness and tolerability of lurasidone in outpatients with bipolar disorder II- A 24 week retrospective study (RETLO-BDIIstudy). J Affect Disord. 2025;379:266-272.
55. Ali Z, Tegin C, El-Mallakh RS. Evaluating lurasidone as a treatment option for bipolar disorder. Expert Opin Pharmacother. 2020;21(3):253-260.
56. McIntyre RS, Cucchiaro J, Pikalov A, Kroger H, Loebel A. Lurasidone in the treatment of bipolar depression with mixed (subsyndromal hypomanic) features: Post hoc analysis of a randomized placebo-controlled trial. J Clin Psychiatry. 2015;76(4):398-405.
57. Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 2018;20(2):97-170.
58. Loebel A, Cucchiaro J, Silva R, Kroger H, Hsu J, Sarma K, et al. Lurasidone monotherapy in the treatment of bipolar I depression: A randomized, double-blind, placebo-controlled study. Am J Psychiatry 2014; 171:160.
