Aripiprazole versus other atypical antipsychotics for schizophrenia
- PMID: 19821375
- PMCID: PMC4164478
- DOI: 10.1002/14651858.CD006569.pub3
Aripiprazole versus other atypical antipsychotics for schizophrenia
Update in
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Aripiprazole versus other atypical antipsychotics for schizophrenia.Cochrane Database Syst Rev. 2013 Feb 28;(2):CD006569. doi: 10.1002/14651858.CD006569.pub4. Cochrane Database Syst Rev. 2013. Update in: Cochrane Database Syst Rev. 2014 Jan 02;(1):CD006569. doi: 10.1002/14651858.CD006569.pub5. PMID: 23450570 Updated.
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.
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Comment in
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Review: is aripiprazole as effective as risperidone in people with schizophrenia?Evid Based Ment Health. 2010 May;13(2):51. doi: 10.1136/ebmh.13.2.51. Evid Based Ment Health. 2010. PMID: 21856614 No abstract available.
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Review: ziprasidone is marginally less effective than other atypical antipsychotics in people with schizophrenia.Evid Based Ment Health. 2010 May;13(2):53. doi: 10.1136/ebmh.13.2.53. Evid Based Ment Health. 2010. PMID: 21856616 No abstract available.
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References
References to studies included in this review
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- 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.
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References to studies excluded from this review
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- 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.
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- 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.
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References to ongoing studies
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- Eli Lilly, Company . Study of olanzapine vs aripiprazole in the treatment of schizophrenia. Eli Lilly and Company Clinical Trial Registry; 2003.
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- 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
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- 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.
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- Arnt J, Skarsfeldt T. Do novel antipsychotics have similar pharmacological characteristics? A review of the evidence. Neuropsychopharmacology. 1998;18:63–101. - PubMed
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- Barnes TR. A rating scale for drug-induced akathisia. British Journal of Psychiatry. 1989;154:672–6. - PubMed
References to other published versions of this review
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- El-Sayeh HG, Morganti C. Aripiprazole for schizophrenia. Cochrane Database of Systematic Reviews. 2006;(2) DOI: 10.1002/14651858.CD004578.pub3.
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