Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2009 Oct 7:(4):CD006569.
doi: 10.1002/14651858.CD006569.pub3.

Aripiprazole versus other atypical antipsychotics for schizophrenia

Affiliations
Meta-Analysis

Aripiprazole versus other atypical antipsychotics for schizophrenia

Katja Komossa et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: In many countries of the industrialised world second generation (atypical) antipsychotics have become first line drug treatments for people with schizophrenia. The question as to whether, and if so how much, the effects of the various second generation antipsychotics differ is a matter of debate. In this review we examine how the efficacy and tolerability of aripiprazole differs from that of other second generation antipsychotics.

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

Search strategy: We searched the Cochrane Schizophrenia Group Trials Register (March 2007) which is based on regular searches of BIOSIS, CENTRAL, CINAHL, EMBASE, MEDLINE and PsycINFO.

Selection criteria: We included all randomised trials comparing oral aripiprazole with oral forms of amisulpride, clozapine, olanzapine, quetiapine, risperidone, sertindole, ziprasidone or zotepine in people with schizophrenia or schizophrenia-like psychoses.

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 (MD) again based on a random-effects model.

Main results: The review currently includes four trials with 1404 participants on two out of eight possible comparisons - aripiprazole versus olanzapine and aripiprazole versus risperidone. The overall number of participants leaving the studies early was considerable (38.5%), limiting the validity of the findings, but with no significant differences between groups. Aripiprazole was less efficacious than olanzapine in terms of the general mental state (PANSS total score: n=794, 2 RCTs, MD 4.96 CI 1.85 to 8.06), but it was associated with fewer side-effects such as cholesterol increase, weight gain, sedation and prolactin associated side-effects. Compared with risperidone there was no difference in efficacy (PANSS total score: n=372, 2 RCTs, MD 1.50 CI -2.96 to 5.96). Dystonia, QTc abnormalities, prolactin and cholesterol increase were less frequent in the aripiprazole group, while tremor was more frequent in the aripiprazole group compared with those allocated risperidone.

Authors' conclusions: Aripiprazole may be somewhat less effective than olanzapine, but more tolerable in terms of metabolic effects and sedation. There is no evidence for a difference in efficacy compared to risperidone, but for better tolerability in terms of dystonias, cholesterol prolactin increase and QTc prolongation. Randomised evidence comparing aripiprazole with other second generation antipsychotic drugs is currently not available.

PubMed Disclaimer

Figures

<b>Figure 1</b>
Figure 1
Methodological quality graph: review authors’ judgements about each methodological quality item presented as percentages across all included studies.
<b>Figure 2</b>
Figure 2
Methodological quality summary: review authors’ judgements about each methodological quality item for each included study.

Comment in

Similar articles

Cited by

References

References to studies included in this review

    1. BMS A multicenter, double-blind, randomized, comparative study of aripiprazole and olanzapine in the treatment of patients with acute schizophrenia. Clinical Study Report. 2005:CN138003.
    2. *

    1. Chan HY, Lin WW, Lin SK, Hwang TJ, Su TP, Chiang SC, Hwu HG. Efficacy and safety of aripiprazole in the acute treatment of schizophrenia in chinese patients with risperidone as an active control: A randomized trial. Journal of Clinical Psychiatry. 2007;68(1):29–36. - PubMed
    2. *

    1. Hwang TJ, Chan HY, Lin WW, Lin SK, Hwu HG, Cheng MY, Forbes RA. Aripiprazole versus risperidone in the treatment of acutely relapsed patients with schizophrenia in Taiwan: a randomized controlled trial. Journal of the European College of Neuropsychopharmacology. 2005;14(Suppl 3):S497.
    1. McQuade RD, Stock E, Marcus R, Jody D, Gharbia NA, Vanveggel S, Carson WH. A comparison of weight change during treatment with olanzapine or aripiprazole: results from a randomized, double-blind study. Journal of Clinical Psychiatry. 2004;65(Suppl 18) - PubMed
    1. Potkin SG, Kujawa M, Carson WH, Saha AR, Ali M, Ingenito G. Aripiprazole and risperidone versus placebo in schizophrenia and schizoaffective disorder. Schizophrenia Research. 2003;60:300. - PubMed

References to studies excluded from this review

    1. Beuzen JN, Pans M, Modell S, Hagens P, McQuade R, Iwamoto T, Carson W. Naturalistic study of aripiprazole treatment; Proceedings of the XIII World Congress of Psychiatry; Cairo, Egypt. Cairo: World Congress of Psychiatry. 2005 10-15th Sept; 2005.
    1. Blonde L, Ray S, Corey-Lisle PK, Cislo PR, L’Italien G. The risk of new-onset type 2 diabetes and coronary heart disease in chronic schizophrenic patients treated with aripiprazole and olanzapine. Journal of the European College of Neuropsychopharmacology. 2004;14(Suppl 3):S275.
    1. Casey D, L’Italien G, Waldeck R, Cislo P, Carson W. Metabolic syndrome comparison between olanzapine, aripiprazole, and placebo; Proceedings of the 156th Annual Meeting of the American Psychiatric Association; San Francisco, California, USA. San Francisco: American Psychiatric Association. 2003 May 17-22; 2003.
    1. Chen J-D, Zhao J-P, Li L-H, Guo X-F, Zhai J-G, Wang C-Y, Xie S-P, Gao C-G, Ding Y,, Chen Y-G. A multicentre, randomised and double-blind controlled trial of aripiprazole in treatment of schizophrenia. Chinese Journal of New Drugs and Clinical Remedies. 2005;11:845–8.
    1. Cornblatt B, Kern RS, Carson WH, Stock E, Ali M, Ingenito G, Green MF. Neurocognitive effects of aripiprazole versus olanzapine in patients with stable psychosis. Schizophrenia Research. 2002;53(3 Suppl 1):27.

References to ongoing studies

    1. Eli Lilly, Company . Study of olanzapine vs aripiprazole in the treatment of schizophrenia. Eli Lilly and Company Clinical Trial Registry; 2003.
    1. Eli Lilly, Company . Olanzapine versus aripiprazole in the treatment of acutely ill patients with schizophrenia. Eli Lilly and Company Clinical Trial Registry; 2004.

Additional references

    1. Altman DG, Bland JM. Detecting skewness from summary information. BMJ. 1996;313:1200. - PMC - PubMed
    1. American Psychiatric Association . American Journal of Psychiatry. 2nd. American Psychiatric Publishing, Inc; 2004. Practice guidelines for the treatment of patients with schizophrenia; pp. 1–114.
    1. Arnt J, Skarsfeldt T. Do novel antipsychotics have similar pharmacological characteristics? A review of the evidence. Neuropsychopharmacology. 1998;18:63–101. - PubMed
    1. Barnes TR. A rating scale for drug-induced akathisia. British Journal of Psychiatry. 1989;154:672–6. - PubMed
    1. Bland JM, Kerry SM. Statistics notes. Trials randomised in clusters. BMJ. 1997;315:600. - PMC - PubMed

References to other published versions of this review

    1. El-Sayeh HG, Morganti C. Aripiprazole for schizophrenia. Cochrane Database of Systematic Reviews. 2006;(2) DOI: 10.1002/14651858.CD004578.pub3.
    1. * Indicates the major publication for the study