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Carcinogenesis
Lifetime carcinogenicity studies were conducted in ICR mice and SD rats. Brexpiprazole
was administered orally for two years to male and female mice at doses of 0.75, 2 and
5 mg/kg/day (0.9 to 6.1 times the oral MRHD of 4 mg/day based on mg/m2 body surface
area) and to male and female rats at doses of 1, 3, and 10 mg/kg and 3, 10, and 30 mg/
kg/day, respectively (2.4 to 24 and 7.3 to 73 times the oral MRHD, males and females).
In female mice, the incidence of mammary gland adenocarcinoma was increased at all
doses and the incidence of adenosquamous carcinoma was increased at 2.4 and 6.1 times
the MRHD. No increase in the incidence of tumors was observed in male mice. In the rat
study, brexpiprazole was not carcinogenic in either sex at doses up to 73 times the MRHD.
Proliferative and/or neoplastic changes in the mammary and pituitary glands of rodents
have been observed following chronic administration of antipsychotic drugs and are
considered to be prolactin mediated. The potential for increasing serum prolactin level
of brexpiprazole was shown in both mice and rats. The relevance for human risk of the
findings of prolactin-mediated endocrine tumors in rodents is unknown.
Mutagenesis
Brexpiprazole was not mutagenic when tested in the in vitro bacterial reverse mutation
assay (Ames test). Brexpiprazole was negative for clastogenic activity in the in vivo
micronucleus assay in rats, and was not genotoxic in the in vivo/in vitro unscheduled DNA
synthesis assay in rats. In vitro with mammalian cells brexpiprazole was clastogenic but
only at doses that induced cytotoxicity. Based on a weight of evidence, brexpiprazole is not
considered to present a genotoxic risk to humans.
Impairment of Fertility
Female rats were treated with oral doses of 0.3, 3 or 30 mg/kg/day (0.7, 7.3, and 73 times
the oral MRHD on a mg/m2 basis) prior to mating with untreated males and continuing
through conception and implantation. Estrus cycle irregularities and decreased fertility
were observed at 3 and 30 mg/kg/day. Prolonged duration of pairing and increased
preimplantation losses were observed at 30 mg/kg/day.
Male rats were treated with oral doses of 3, 10, or 100 mg/kg/day (7.3, 24 and 240 times
the oral MRHD on a mg/m2 basis) for 63 days prior to mating with untreated females and
throughout the 14 days of mating. No differences were observed in the duration of mating
or fertility indices in males at any dose of brexpiprazole.

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