Efficacy and safety of aripiprazole for the treatment of schizophrenia: an overview of systematic reviews
- 922 Downloads
To conduct an overview to summarize the efficacy and safety of aripiprazole for the treatment of schizophrenia.
A literature search was performed in PubMed, the Cochrane Library, LILACS, and the Centre for Reviews and Dissemination, for articles published until March 31, 2017. We included systematic reviews with meta-analyses of randomized controlled trials assessing the efficacy, and/or the safety of aripiprazole, for patients with schizophrenia. Two authors independently performed the study selection, data extraction, and quality assessment. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and the Risk of Bias in Systematic Review (ROBIS) tool were used to appraise the quality of evidence and the risk of bias in the reviews, respectively.
Fourteen studies fulfilled the inclusion criteria. Aripiprazole showed efficacy similar to that of both typical and atypical antipsychotic drugs (except olanzapine and amisulpride). Aripiprazole caused significantly lower weight gain and alterations in glucose and cholesterol levels, as compared to clozapine, risperidone, and olanzapine. In addition, aripiprazole caused significantly fewer general extrapyramidal side effects, less use of antiparkinsonian drugs, and akathisia, compared with typical antipsychotic drugs and risperidone. The overall quality of evidence in the reviews ranged from “very low” to “moderate,” principally because of the risk of bias of original trials, inconsistency, and imprecision in the outcomes. According to the ROBIS tool, there are four reviews with “high” risk of bias and five with “unclear” risk of bias.
Aripiprazole exhibited efficacy similar to that of other antipsychotic drugs and a better safety profile than that of typical (i.e., less some extrapyramidal side effects) and atypical (i.e., less metabolic changes) antipsychotic drugs.
KeywordsMental disorder Schizophrenia Aripiprazole Systematic review Overview
E.L.A.R. and P.M.A. planned the study. E.L.A.R. and T.M.L. performed the literature search and the qualitative analysis, supervised by P.M.A. E.L.A.R. wrote the first draft, and T.M.L., M.E.B.V., S.S., and P.M.A. reviewed the manuscript. All authors contributed to and have approved the final manuscript.
Compliance with ethical standards
Conflict of interest
The authors have no potential conflicts of interest relevant to disclose. The research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
- 1.American Psychiatric Association (APA) (2013) Diagnostic and statistical manual of mental disorders. 5th ed. 2. Mental disorders—classification. 3. Mental disorders—diagnosisGoogle Scholar
- 6.Seida JC, Schouten JR, Mousavi SS, Hamm M, Beaith A, Vandermeer B, et al. (2012) First- and second-generation antipsychotics for children and young adults. Comparative Effectiveness Review No. 39. (Prepared by the University of Alberta Evidence-based Practice Center under Contract No. 290–2007-10021.) AHRQ Publication No. 11(12)-EHC077-EF. Rockville: Agency for Healthcare Research and QualityGoogle Scholar
- 9.Divac N, Prostran M, Jakovcevski I, Cerovac N (2014) Review article second-generation antipsychotics and extrapyramidal adverse effects. Biomed Res Int 2014:656370Google Scholar
- 12.Schünemann H, Brozek J, Guyatt G, Oxman A, editors (The GRADE Working Group) (2013) GRADE handbook for grading quality of evidence and strength of recommendations. Available from: http://www.guidelinedevelopment.org/handbook. Accessed May 12, 2017
- 15.Bai Z, Wang G, Cai S, Ding X, Liu W, Huang D, Shen W, Zhang J, Chen K, Yang Y, Zhang L, Zhao X, Ouyang Q, Zhao J, Lu H, Hao W (2017) Efficacy, acceptability and tolerability of 8 atypical antipsychotics in Chinese patients with acute schizophrenia: a network meta-analysis. Schizophr Res 185:73–79CrossRefPubMedGoogle Scholar
- 16.Belgamwar RB, El-Sayeh HG (2011) Aripiprazole versus placebo for schizophrenia. Cochrane Database Syst Rev (8):CD006622Google Scholar
- 17.Bhattacharjee J, El-Sayeh HG (2008) Aripiprazole versus typical antipsychotic drugs for schizophrenia. Cochrane Database Syst Rev (3):CD006617Google Scholar
- 18.Khanna P, Komossa K, Rummel-Kluge C, Hunger H, Schwarz S, El-Sayeh HG, et al (2014) Aripiprazole versus other atypical antipsychotics for schizophrenia. Cochrane Database Syst Rev (2):CD006569Google Scholar
- 23.Leucht S, Cipriani A, Spineli L, Mavridis D, Örey D, Richter F, Samara M, Barbui C, Engel RR, Geddes JR, Kissling W, Stapf MP, Lässig B, Salanti G, Davis JM (2013) Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. Lancet 382(9896):951–962CrossRefPubMedGoogle Scholar
- 24.Majer IM, Gaughran F, Sapin C, Beillat M, Treur AM (2015) Efficacy, tolerability, and safety of aripiprazole once-monthly versus other long-acting injectable antipsychotic therapies in the maintenance treatment of schizophrenia: a mixed treatment comparison of double-blind randomized clinical trials. J Mark Access Health Policy 3. doi https://doi.org/10.3402/jmahp.v3.27208
- 27.Rummel-Kluge C, Komossa K, Schwarz S, Hunger H, Schmid F, Lobos CA, Kissling W, Davis JM, Leucht S (2010) Head-to-head comparisons of metabolic side effects of second generation antipsychotics in the treatment of schizophrenia: a systematic review and meta-analysis. Schizophr Res 123(2–3):225–233CrossRefPubMedPubMedCentralGoogle Scholar
- 33.Joy CB, Adams CE, Lawrie SM (2006) Haloperidol versus placebo for schizophrenia. Cochrane Database Syst Rev (4):CD003082Google Scholar
- 36.Nawal W, Komal W, Muhammad WS (2017) Bupropion-induced acute dystonia with dose escalation and use of Naranjo nomogram. Cureus 9(4):e1157Google Scholar