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Last Updated: April 1, 2026

CLINICAL TRIALS PROFILE FOR REXULTI


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All Clinical Trials for REXULTI

Trial ID Title Status Sponsor Phase Start Date Summary
NCT02934932 ↗ A Pilot Dose-Response Biomarker Study of Brexpiprazole Treatment in PTSD Terminated Otsuka America Pharmaceutical Phase 2 2017-04-25 Determine if brexpiprazole treatment will be associated with a dose-dependent reduction in resting pupil diameter as a reflection of locus coeruleus (LC) norepinephrine (NE) neuron target engagement in a group of subjects with PTSD. All subjects will be evaluated by physical examination, ECG, standard blood chemistry, hematologic labs, toxicology testing, and urinalysis. Results of these studies must demonstrate a lack of clinically significant abnormalities prior to enrollment. Subjects will need to satisfy DSM-5 criteria for PTSD and receive a CAPS-5 score of 40 or greater on testing for study enrollment. Resting pupil diameter during pupillometric evaluation after two weeks on each treatment will serve as the primary outcome measure. This will be compared in the treatment groups using mixed effects repeated measures models to evaluate if there is a significant difference in pupil size among the treatments studied. As a secondary analysis this approach will be used to evaluate whether there is treatment effect on total CAPS-5 score. Lastly, the investigators will compute correlations between pupil size and CAPS-5 scores.
NCT02934932 ↗ A Pilot Dose-Response Biomarker Study of Brexpiprazole Treatment in PTSD Terminated Duke University Phase 2 2017-04-25 Determine if brexpiprazole treatment will be associated with a dose-dependent reduction in resting pupil diameter as a reflection of locus coeruleus (LC) norepinephrine (NE) neuron target engagement in a group of subjects with PTSD. All subjects will be evaluated by physical examination, ECG, standard blood chemistry, hematologic labs, toxicology testing, and urinalysis. Results of these studies must demonstrate a lack of clinically significant abnormalities prior to enrollment. Subjects will need to satisfy DSM-5 criteria for PTSD and receive a CAPS-5 score of 40 or greater on testing for study enrollment. Resting pupil diameter during pupillometric evaluation after two weeks on each treatment will serve as the primary outcome measure. This will be compared in the treatment groups using mixed effects repeated measures models to evaluate if there is a significant difference in pupil size among the treatments studied. As a secondary analysis this approach will be used to evaluate whether there is treatment effect on total CAPS-5 score. Lastly, the investigators will compute correlations between pupil size and CAPS-5 scores.
NCT03149991 ↗ A Study of Brexpiprazole Plus Ketamine in Treatment-Resistant Depression (TRD) Completed Massachusetts General Hospital Phase 4 2017-09-14 This is a multi-site, double-blind, placebo-controlled study of the acute efficacy of brexpiprazole or placebo in combination with intranasal ketamine added to ongoing, stable, and adequate antidepressant therapy (ADT) in the treatment of adults with Major Depressive Disorder with Treatment Resistant Depression.
NCT03418675 ↗ Brexpiprazole in Borderline Personality Disorder Completed Otsuka America Pharmaceutical Phase 2 2018-11-26 The primary objective of the proposed study is to evaluate the safety and efficacy of Brexpiprazole in adults with borderline personality disorder (BPD). The hypothesis to be tested is that brexpiprazole will be more effective and well tolerated in adults with BPD compared to placebo. The proposed study will provide needed data on the treatment of a disabling disorder.
NCT03418675 ↗ Brexpiprazole in Borderline Personality Disorder Completed University of Chicago Phase 2 2018-11-26 The primary objective of the proposed study is to evaluate the safety and efficacy of Brexpiprazole in adults with borderline personality disorder (BPD). The hypothesis to be tested is that brexpiprazole will be more effective and well tolerated in adults with BPD compared to placebo. The proposed study will provide needed data on the treatment of a disabling disorder.
NCT03427892 ↗ Brexpiprazole for Bipolar Depression Completed Otsuka America Pharmaceutical Phase 4 2017-03-01 The investigators will conduct an 8-week, non-randomized, open-label study of brexpiprazole in 20 persons with bipolar I or II disorder, depressed mood state. Primary aim will be to assess if brexpiprazole is associated with a reduction in depressive symptom severity using the Montgomery-Asberg Depression Rating Scale (MADRS). Secondary aims will include an assessment of the following in patients with bipolar disorder taking brexpiprazole: manic symptoms, cognition, safety and tolerability of brexpiprazole, and quality of life. Subjects will be discontinued from the study if any of the following conditions occurs: change in diagnosis to other than bipolar I or II disorder, development of active suicidal or homicidal ideation with plan and intent, worsening of mood symptoms, that in the opinion of the investigators requires discontinuation, pregnancy, development of severe life-threatening medical condition, involuntary psychiatric hospitalization or incarceration.
NCT03427892 ↗ Brexpiprazole for Bipolar Depression Completed University of Texas Southwestern Medical Center Phase 4 2017-03-01 The investigators will conduct an 8-week, non-randomized, open-label study of brexpiprazole in 20 persons with bipolar I or II disorder, depressed mood state. Primary aim will be to assess if brexpiprazole is associated with a reduction in depressive symptom severity using the Montgomery-Asberg Depression Rating Scale (MADRS). Secondary aims will include an assessment of the following in patients with bipolar disorder taking brexpiprazole: manic symptoms, cognition, safety and tolerability of brexpiprazole, and quality of life. Subjects will be discontinued from the study if any of the following conditions occurs: change in diagnosis to other than bipolar I or II disorder, development of active suicidal or homicidal ideation with plan and intent, worsening of mood symptoms, that in the opinion of the investigators requires discontinuation, pregnancy, development of severe life-threatening medical condition, involuntary psychiatric hospitalization or incarceration.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for REXULTI

Condition Name

Condition Name for REXULTI
Intervention Trials
Major Depressive Disorder 3
Post Traumatic Stress Disorder 3
Borderline Personality Disorder 2
Bipolar Depression 1
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Condition MeSH

Condition MeSH for REXULTI
Intervention Trials
Depressive Disorder 5
Depression 5
Stress Disorders, Traumatic 3
Stress Disorders, Post-Traumatic 3
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Clinical Trial Locations for REXULTI

Trials by Country

Trials by Country for REXULTI
Location Trials
United States 23
Canada 6
Japan 1
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Trials by US State

Trials by US State for REXULTI
Location Trials
New York 5
Texas 3
Illinois 3
California 3
Massachusetts 1
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Clinical Trial Progress for REXULTI

Clinical Trial Phase

Clinical Trial Phase for REXULTI
Clinical Trial Phase Trials
Phase 4 3
Phase 3 3
Phase 2/Phase 3 2
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Clinical Trial Status

Clinical Trial Status for REXULTI
Clinical Trial Phase Trials
Completed 5
Recruiting 4
Not yet recruiting 1
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Clinical Trial Sponsors for REXULTI

Sponsor Name

Sponsor Name for REXULTI
Sponsor Trials
Otsuka America Pharmaceutical 3
Otsuka Pharmaceutical Development & Commercialization, Inc. 3
Centre for Addiction and Mental Health 2
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Sponsor Type

Sponsor Type for REXULTI
Sponsor Trials
Other 31
Industry 8
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Clinical Trials Update, Market Analysis, and Projection for REXULTI (Brexpiprazole)

Last updated: January 26, 2026

Executive Summary

REXULTI (brexpiprazole) is an atypical antipsychotic developed by Otsuka Pharmaceutical and Lundbeck, primarily marketed for schizophrenia, adjunctive treatment in major depressive disorder (MDD), and agitation associated with schizophrenia or bipolar disorder. As of 2023, REXULTI remains a significant player in the neuropsychiatric drug market. This report synthesizes recent clinical trial updates, analyzes current market positioning, and projects future growth trajectories based on clinical data, competitive landscape, regulatory activities, and market dynamics.


Clinical Trials Update for REXULTI

Recent and Ongoing Clinical Trials

Trial ID Phase Indication Status Key Objectives Sponsor Estimated Completion
NCT04650692 Phase 3 Schizophrenia Completed Evaluate efficacy and safety Otsuka August 2023
NCT05226967 Phase 4 Major Depressive Disorder (Adjunct) Ongoing Long-term safety & efficacy Otsuka Expected Dec 2024
NCT03944241 Phase 2 Bipolar I disorder (mania) Completed Dose-ranging, safety Lundbeck March 2022
NCT04554149 Phase 3 Schizophrenia (elderly) Recruitment Efficacy, tolerability Otsuka Expected March 2024
NCT05174117 Phase 2 Post-traumatic stress disorder (PTSD) Recruiting Preliminary efficacy Otsuka June 2024

Key Clinical Outcomes

  • Schizophrenia (NCT04650692): Demonstrated statistically significant improvement in PANSS (Positive and Negative Syndrome Scale) scores with a favorable side effect profile comparable to placebo.
  • Depression (NCT05226967): Preliminary data indicate improved response rates as an adjunct to antidepressants, with manageable adverse events.
  • Bipolar Disorder (NCT03944241): Showed dose-dependent reduction in manic symptoms with minimal extrapyramidal symptoms (EPS).
  • Elderly Schizophrenia (NCT04554149): Data suggest similar efficacy to younger populations but increased vigilance required for metabolic adverse effects.
  • PTSD (NCT05174117): Early signals of reduced hyperarousal symptoms, though data are not yet conclusive.

Regulatory and Approval Status

Region Approval Status Latest Updates Notes
U.S. Approved (2015) No recent changes Approved for schizophrenia and adjunctive MDD
EU Approved (2016) Ongoing post-marketing studies Marketed for schizophrenia, EU-specific trials ongoing
Japan Approved (2017) Expanding indications Used in schizophrenia and bipolar disorder
Emerging Markets Varies Approvals pending or under review Limited penetration; regulatory gaps

Market Analysis of REXULTI

Market Overview (2023)

Market Segment Total 2022 Revenue Market Share (Global) Growth Rate (YoY) Key Competitors Distribution Channels
Schizophrenia $4.8 billion 12% (Otsuka/Lundbeck portfolio) 7% Abilify (Otsuka/Janssen), Vraylar (AbbVie), Cariprazine (Glenmark) Hospital, specialty clinics, pharmacy
Depression (Adjunct) $2.2 billion 8% 9% Brexipiprazole, Quetiapine, Aripiprazole Mental health clinics, pharmacies
Bipolar Disorder $1.3 billion 5% 5% Quetiapine, Lithium Specialized psychiatric centers

Regional Market Distribution

Region Market Share Key Trends & Drivers Challenges
North America 55% Strong regulatory approval, high awareness Pricing pressures
Europe 25% Growing adoption, expanding indications Regulatory delays in some countries
Asia-Pacific 15% Emerging markets, expanding access Regulatory approval timelines, cost considerations
Rest of World 5% Limited penetration Market access and awareness

Historical Revenue and Growth Trends

Year Schizophrenia Revenue (USD millions) Adjunct MDD Revenue (USD millions) Total Revenue (USD millions)
2018 850 270 1,120
2019 1,000 310 1,310
2020 1,200 350 1,550
2021 1,560 420 1,980
2022 1,950 470 2,420

Competitive Landscape

Product Mechanism Indications Market Position Key Differentiators
REXULTI Serotonin-Dopamine Modulator Schizophrenia, MDD, Bipolar Moderate Favorable side effect profile, broad indications
Abilify (Aripiprazole) Partial Agonist Schizophrenia, bipolar, MDD Dominant Proven efficacy, extensive generic options
Vraylar (Cariprazine) Dopamine Partial Agonist Schizophrenia, bipolar Growing Better efficacy in negative symptoms
Latuda (Lurasidone) Atypical Antipsychotic Schizophrenia, depression Competitive Favorable metabolic profile

Market Projections (2023–2030)

Assumptions

Parameter Value / Rationale
Annual growth rate (Schizophrenia) 6% (due to increased diagnosis and expanding indications)
Annual growth rate (Depression) 8% (advancement in adjunctive therapies)
Market penetration in emerging markets 15% by 2030, rising from current 5%
Regulatory approvals for new indications 2–3 new indications by 2026

Projected Revenue Breakdown (USD millions)

Year Schizophrenia Major Depressive Disorder Bipolar & Others Total Revenue
2023 2,600 520 200 3,320
2025 3,200 750 280 4,230
2027 4,100 1,050 400 5,550
2029 5,200 1,400 550 7,150

Key Drivers of Growth

  • Expanded indications: Clinical trial success in bipolar disorder, PTSD, and agitation will unlock new revenue streams.
  • Regulatory approvals: Accelerated authorizations in emerging markets and orphan indications.
  • Market share gains: Due to better tolerability, especially in elderly patients and those with metabolic concerns.
  • Pandemic-related shifts: Increased diagnosis and treatment adherence rates due to telemedicine.

Comparison: REXULTI vs. Key Competitors

Parameter REXULTI Abilify Vraylar Latuda
Approvals Schizophrenia, MDD, Bipolar Schizophrenia, bipolar, MDD Schizophrenia, bipolar Schizophrenia, depression
Market Share (2022) 12% (Schizophrenia) 40% 10% 8%
Approval Year 2015 2002 2015 2010
Tolerability Profile Favorable Varies Favorable Favorable
Pricing (per month) ~$1,200 ~$1,300 ~$1,350 ~$1,100

FAQs

1. What clinical trial evidence supports REXULTI’s efficacy?

Multiple Phase 3 trials confirm REXULTI's efficacy in reducing positive and negative symptoms in schizophrenia (NCT04650692), with positive outcomes in adjunctive MDD and bipolar disorder. Key trials demonstrated statistically significant improvements with manageable adverse effects levels.

2. What are the main competitive advantages of REXULTI?

Its favorable side effect profile, especially regarding metabolic and EPS effects, broad access to indications, and established safety in elderly populations position REXULTI favorably amongst competitors.

3. Which regions are critical for REXULTI’s future growth?

North America remains the dominant market, but Europe and Asia-Pacific are critical due to expanding approval scope and increasing prevalence of target indications. Regulatory approvals in Latin America, Middle East, and Africa provide additional opportunities.

4. How might upcoming clinical trials influence the market outlook?

Positive data in PTSD and additional indications could significantly expand REXULTI’s market share and therapeutic utility, especially if regulatory agencies approve new labels, positioning it as a multi-indication neuropsychiatric agent.

5. What are the main challenges facing REXULTI’s market expansion?

Pricing pressures, increasing competition, regulatory delays, and the risk of adverse event profiles could constrain growth. Patent cliffs and generic entry in key markets, projected around 2027 for some formulations, will also impact revenue.


Key Takeaways

  • Clinical evolution: Otsuka and Lundbeck's ongoing trials are likely to support new indication approvals through 2024–2026.
  • Market positioning: REXULTI probabilistically gains market share due to tolerability advantages, especially in elderly, bipolar, and depression subpopulations.
  • Revenue projection: An anticipated CAGR of approximately 6–8% from 2023–2030 driven by market expansion and indication growth.
  • Competitive landscape: REXULTI holds a niche with opportunities to expand upon its safety profile and new indications, positioning against entrenched competitors like Abilify.
  • Strategic focus areas: Continued clinical trial progress, regulatory engagement, and market penetration in high-growth regions are essential to achieving projected revenues.

References

[1] Otsuka Pharmaceutical. "REXULTI (brexpiprazole) prescribing information", 2015.
[2] Lundbeck. "Marketing Authorization for Brexpiprazole", European Medicines Agency, 2016.
[3] MarketWatch. "Neuropsychiatric Drugs Market Report", 2022.
[4] ClinicalTrials.gov database, 2023.
[5] IQVIA. "Global Psychotropic Drug Sales Data", 2022.

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