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. 2008 Jul 16;2008(3):CD006617.
doi: 10.1002/14651858.CD006617.pub3.

Aripiprazole versus typical antipsychotic drugs for schizophrenia

Jayanti Bhattacharjee  1 , Hany George G El-Sayeh
Affiliations

Aripiprazole versus typical antipsychotic drugs for schizophrenia

Jayanti Bhattacharjee et al. Cochrane Database Syst Rev. .

Abstract

Background: Aripiprazole is a relatively new antipsychotic drug, said to be the prototype of a new third generation of antipsychotics; the so-called dopamine-serotonin system stabilisers. In this review we examine how the efficacy and tolerability of aripiprazole differs from that of typical antipsychotics.

Objectives: To evaluate the effects of aripiprazole compared with other typical antipsychotics for people with schizophrenia and schizophrenia-like psychoses.

Search strategy: We searched the Cochrane Schizophrenia Group Trials Register (November 2007) which is based on regular searches of BIOSIS, CENTRAL, CINAHL, EMBASE, MEDLINE and PsycINFO. We inspected references of all identified studies for further trials. We contacted relevant pharmaceutical companies, drug approval agencies and authors of trials for additional information.

Selection criteria: We included all randomised trials comparing aripiprazole with typical antipsychotics in people with schizophrenia or schizophrenia-like psychosis.

Data collection and analysis: We extracted data independently. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis, based on a random effects model. We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. For continuous data, we calculated weighted mean differences (WMD) again based on a random effects model. We have contacted representatives of Bristol Myers Squibb pharmaceuticals (UK) for additional data.

Main results: We included nine randomised trials involving 3122 people comparing aripiprazole with typical antipsychotic drugs. None of the studies reported on relapse - our primary outcome of interest. Attrition from studies was high and data reporting poor. Participants given aripiprazole were comparable to those receiving typical drugs in improving global state and mental state. Aripiprazole provided a significant advantage over typical antipsychotics in terms of fewer occurrences of extra-pyramidal symptom (n=968, 3 RCT, RR 0.46 CI 0.3 to 0.9, NNT 13 CI 17 to 10), and particularly akathisia (n=897, 3 RCT, RR 0.39 CI 0.3 to 0.6, NNT 11 CI 14 to 9). Fewer participants given aripiprazole developed hyperprolactinaemia (n=300, 1 RCT, RR 0.07 CI 0.03 to 0.2, NNT 2 CI 3 to 1). Aripiprazole presented a lesser risk of sinus tachycardia (n=289, 1 RCT, RR 0.09 CI 0.01 to 0.8, NNT 22 CI 63 to 13) and blurred vision (n=308, 1 RCT, RR 0.19 CI 0.1 to 0.7, NNT 14 CI 25 to 10); but enhanced risk of occurrence of dizziness (n=957, 3 RCT, RR 1.88 CI 1.1 to 3.2, NNH 20 CI 33 to 14) and nausea (n=957, 3 RCT, RR 3.03 CI 1.5 to 6.1, NNH 17 CI 25 to 13). Attrition rates were high in both groups, although significantly more participants in the aripiprazole group completed the study in the long term (n=1294, 1 RCT, RR 0.81 CI 0.8 to 0.9 NNT 8 CI 5 to 14).

Authors' conclusions: Aripiprazole differs little from typical antipsychotic drugs with respect to efficacy, however it presents significant advantages in terms of tolerability. Clearly reported pragmatic short, medium and long term randomised controlled trials are required to replicate and validate these findings and determine the position of aripiprazole in everyday clinical practice.

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Conflict of interest statement

Jayanti Bhattacharjee ‐ None known Hany George El‐Sayeh ‐ None known

Figures

1.1
1.1. Analysis
Comparison 1 Aripiprazole versus typical antipsychotic drugs(short term
1.2
1.2. Analysis
Comparison 1 Aripiprazole versus typical antipsychotic drugs(short term
1.3
1.3. Analysis
Comparison 1 Aripiprazole versus typical antipsychotic drugs(short term
1.4
1.4. Analysis
Comparison 1 Aripiprazole versus typical antipsychotic drugs(short term
1.5
1.5. Analysis
Comparison 1 Aripiprazole versus typical antipsychotic drugs(short term
1.6
1.6. Analysis
Comparison 1 Aripiprazole versus typical antipsychotic drugs(short term
1.7
1.7. Analysis
Comparison 1 Aripiprazole versus typical antipsychotic drugs(short term
1.8
1.8. Analysis
Comparison 1 Aripiprazole versus typical antipsychotic drugs(short term
1.9
1.9. Analysis
Comparison 1 Aripiprazole versus typical antipsychotic drugs(short term
1.10
1.10. Analysis
Comparison 1 Aripiprazole versus typical antipsychotic drugs(short term
2.1
2.1. Analysis
Comparison 2 Aripiprazole versus typical antipsychotic drugs(medium / long term > 12 weeks), Outcome 1 Death.
2.2
2.2. Analysis
Comparison 2 Aripiprazole versus typical antipsychotic drugs(medium / long term > 12 weeks), Outcome 2 Leaving study early.
See this image and copyright information in PMC

Update of

References

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Daniel 2004 {published data only}
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    1. Modell S, Daniel D, Stock E, Wilber R, Marcus R, Carson W, Manos G, Iwamoto T. Intramuscular aripiprazole treatment for acute agitation in patients with psychosis. XXIVth Collegium Internationale Neuro‐Psychopharmacologicum Congress; 2004 June 20‐24, Paris, France 2004. [P12.203]
    1. Tran‐Johnson TK, Sack DA, Marcus RN, Auby P, McQuade RD, Oren DA. Efficacy and safety of intramuscular aripiprazole in patients with acute agitation: a randomised double‐blind,placebo‐controlled trial. Journal of Clinical Psychiatry 2007;68(1):111‐9. [MEDLINE: ; EMBASE 2007077930] - PubMed
Kane 2003 {published data only}
    1. Gismondi R, Meltzer H, Kujawa M, Carson W, Stringfellow J, Iwamoto T, Marcus R, Stock E. Aipiprazole versus perphenazine in treatment‐resistant schizophrenia. XXIVth Collegium Internationale Neuro‐Psychopharmacologicum Congress ; 2004 June 20‐24, Paris, France 2004. [P12.P203]
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Kujawa 2002 {published data only}
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McCue 2006 {published data only}
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Oren 2005 {published data only}
    1. Andrezina R, Josiassen RC, Marcus RN, Oren DA, Manos G, Stock E, Carson WH, Iwamoto T. Intramuscular aripiprazole for the treatment of acute agitation in patients with schizophrenia or schizoaffective disorder ; a double‐blind, placebo‐controlled comparison with intramuscular haloperidol. Psychopharmacology 2006;188(3):281‐92. [MEDLINE: ; EMBASE 2006450840] - PubMed
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Wang 2005 {published data only}
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References to studies excluded from this review

Allen 2007 {published data only}
    1. Allen M, Talbott S, Eudicone J, McQuade R, Pikalov A. Similar rates of agitation, anxiety and insomnia in sedating and non‐sedating antipsychotics: evaluating clinical trial results with aripiprazole, haloperidol and olanzapine. Schizophrenia Bulletin 2007;33(2):418. [ISIP:000244506601017]
Andrezina 2006 {published data only}
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Argo 2004 {published data only}
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Carson 2002 {published data only}
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Carson 2004 {published data only}
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Casey 2002 {published data only}
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Jung 2007 {published data only}
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Kelemen 2006 {published data only}
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Kim 2006 {published data only}
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Kim 2007 {published data only}
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Shim 2006 {published data only}
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Swanson 2006 {published data only}
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Talbott 2007 {published data only}
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Wu 2005 {published data only}
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Xia 2005 {published data only}
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References to studies awaiting assessment

Ao 2006 {published data only}
    1. Ao X, Shao Q, Song H‐M. Comparative study between aripiprazole and chlorpromazine in the treatment of female patients with schizophrenia. Title only available in chinese characters 2006;18(17):719‐20. [Library number =81082A]
Cheng 2006 {published data only}
    1. Cheng P. Title only available in Chinese characters. Nervous Diseases and Mental Health 2006;6(3):203‐4. [Library number =84069X]
Currier 2006 {published data only}
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Daniel 2006 {published data only}
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Daniel 2007 {published data only}
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Lin 2006 {published data only}
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Lu 2006 {published data only}
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Wang 2006 {published data only}
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Xu 2006 {published data only}
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Zhang 2005 {published data only}
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Zhang 2006 {published data only}
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Zhuang 2006 {published data only}
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