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Aripiprazole vs. brexpiprazole for acute schizophrenia: a systematic review and network meta-analysis

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Abstract

Rationale

What is the difference between aripiprazole and brexpiprazole?

Objectives

This systematic review, network meta-analysis of randomized trials evaluated the efficacy and safety/tolerability of aripiprazole and brexpiprazole for treating acute schizophrenia.

Methods

We searched Scopus, MEDLINE, and Cochrane Library from inception until May 22, 2019. The response rate was set as the primary outcome. Other outcomes were discontinuation rate and incidence of individual adverse events. The risk ratio (RR) and 95% credible interval (95%CrI) were calculated.

Results

Fourteen studies were identified (n = 3925). Response rates of both aripiprazole and brexpiprazole were superior to that of the placebo (RR [95%CrI]: aripiprazole = 0.84 [0.78, 0.92], brexpiprazole = 0.84 [0.77, 0.92]). Aripiprazole and brexpiprazole were associated with a lower incidence of all-cause discontinuation (0.80 [0.71, 0.89], 0.83 [0.72, 0.95]), adverse events (0.67 [0.47, 0.97], 0.64 [0.46, 0.94]), and inefficacy (0.56 [0.40, 0.77], 0.68 [0.48, 0.99]) compared with the placebo. Although brexpiprazole was associated with a lower incidence of schizophrenia as an adverse event compared with the placebo (0.57 [0.37, 0.85]), aripiprazole and brexpiprazole were associated with a higher incidence of weight gain compared with the placebo (2.12 [1.28, 3.68], 2.14 [1.35, 3.42]). No significant differences were found in other individual adverse events, such as somnolence, akathisia, extrapyramidal symptoms, and dizziness between aripiprazole or brexpiprazole and placebo. Any outcome between aripiprazole and brexpiprazole were not different.

Conclusions

Differences in short-term efficacy and safety for acute schizophrenia were not apparent between aripiprazole and brexpiprazole. Future studies are warranted to evaluate whether there are differences in the long-term outcome between treatments.

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Acknowledgments

We thank Otsuka Pharmaceutical Co., Ltd. (Tokyo, Japan 〒101-8535) for providing unpublished information and data for this study.

Author information

Authors and Affiliations

  1. Department of Psychiatry, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan

    Taro Kishi, Kenji Sakuma & Nakao Iwata

  2. Digital Neuroscience Laboratory, Department of Communication Sciences and Disorders, The University of Mississippi, Oxford, MS, USA

    Toshikazu Ikuta

  3. Department of Psychiatry, Jikei University School of Medicine, Minato-ku, Tokyo, Japan

    Yuki Matsuda

Authors
  1. Taro Kishi
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  2. Toshikazu Ikuta
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  3. Yuki Matsuda
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  4. Kenji Sakuma
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  5. Nakao Iwata
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Contributions

Dr. Kishi had full access to all of the data in the study and takes full responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design, analysis, and interpretation of data: T. Kishi.

Statistical analysis: T. Kishi and T. Ikuta.

Acquisition of data: T. Kishi, Y. Matsuda, and K. Sakuma.

Drafting of the manuscript: All of the authors.

Study supervision: N. Iwata.

Corresponding author

Correspondence to Taro Kishi.

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Conflict of interest

The authors have declared that there are no potential conflicts of interest in relation to the subject of this study. We have had the following interests within the last 3 years.

Dr. Kishi has received speaker’s honoraria from Daiichi Sankyo, Dainippon Sumitomo, Eisai, Eli Lilly, Janssen, Kyowa, Otsuka, Pfizer, Meiji, MSD, Sumitomo Pharmaceuticals (Suzhou), Yoshitomi, and Tanabe-Mitsubishi and has received a Health Labour Sciences Research Grant, Grant-in-Aid for Scientific Research (C), and a Fujita Health University School of Medicine research grant.

Dr. Ikuta received speaker’s honoraria from Eli Lilly, Daiichi Sankyo, and Dainippon Sumitomo and is a consultant for Dainippon Sumitomo.

Dr. Matsuda has received speaker’s honoraria from Dainippon Sumitomo, Eisai, Otsuka, Tanabe-Mitsubishi, and Pfizer and has received a grant-in-aid for Young Scientists (B).

Dr. Sakuma has received speaker’s honoraria from Eisai, Kissei, Meiji, Otsuka, and Torii and has received a grant-in-aid for Young Scientists (B).

Dr. Iwata has received speaker’s honoraria from Astellas, Dainippon Sumitomo, Eli Lilly, GlaxoSmithKline, Janssen, Yoshitomi, Otsuka, Meiji, Shionogi, Novartis, and Pfizer and has received research grants from Daiichi Sankyo, Dainippon Sumitomo, Meiji, and Otsuka.

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Kishi, T., Ikuta, T., Matsuda, Y. et al. Aripiprazole vs. brexpiprazole for acute schizophrenia: a systematic review and network meta-analysis. Psychopharmacology 237, 1459–1470 (2020). https://doi.org/10.1007/s00213-020-05472-5

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