Lurasidone compared to other atypical antipsychotic monotherapies for adolescent schizophrenia: a systematic literature review and network meta-analysis

Abstract

This network meta-analysis assessed the efficacy and tolerability of lurasidone versus other oral atypical antipsychotic monotherapies in adolescent schizophrenia. A systematic literature review identified 13 randomized controlled trials of antipsychotics in adolescents with schizophrenia-spectrum disorders. A Bayesian network meta-analysis compared lurasidone to aripiprazole, asenapine, clozapine, olanzapine, paliperidone extended-release (ER), quetiapine, risperidone, and ziprasidone. Outcomes included Positive and Negative Syndrome Scale (PANSS), Clinical Global Impressions-Severity (CGI-S), weight gain, all-cause discontinuation, extrapyramidal symptoms (EPS), and akathisia. Results were reported as median differences for continuous outcomes and odds ratios (ORs) for binary outcomes, along with 95% credible intervals (95% CrI). Lurasidone was significantly more efficacious than placebo on the PANSS (- 7.95, 95% CrI - 11.76 to - 4.16) and CGI-S (- 0.44, 95% CrI - 0.67 to - 0.22) scores. Lurasidone was associated with similar weight gain to placebo and statistically significantly less weight gain versus olanzapine (- 3.62 kg, 95% CrI - 4.84 kg to - 2.41 kg), quetiapine (- 2.13 kg, 95% CrI - 3.20 kg to - 1.08 kg), risperidone (- 1.16 kg, 95% CrI - 2.14 kg to - 0.17 kg), asenapine (- 0.98 kg, 95% CrI - 1.71 kg to - 0.24 kg), and paliperidone ER (- 0.85 kg, 95% CrI - 1.57 kg to - 0.14 kg). The odds of all-cause discontinuation were significantly lower for lurasidone than aripiprazole (OR = 0.28, 95% CrI 0.10-0.76) and paliperidone ER (OR = 0.25, 95% CrI 0.08-0.81) and comparable to other antipsychotics. Rates of EPS and akathisia were similar for lurasidone and other atypical antipsychotics. In this network meta-analysis of atypical antipsychotics in adolescent schizophrenia, lurasidone was associated with similar efficacy, less weight gain, and lower risk of all-cause discontinuation compared to other oral atypical antipsychotics.

Keywords: Adolescent; Body weight changes; Lurasidone; Network meta-analysis; Schizophrenia.

Fig. 1

PRISMA flow diagram. Study D1050301 was not published when the literature search was conducted. It is referred to in the text either by the study identifier or the publication, Goldman et al. [37], where appropriate. One trial [36] met all of the selection criteria, but compared two dosing regimens of risperidone. When doses were pooled, it effectively became a one-arm trial and could not be linked into the network

Fig. 2

Comparison of PANSS Total Score Improvement for Lurasidone Relative to Comparators. Abbreviation: PANSS, Positive and Negative Syndrome Scale. *Statistically significant compared to lurasidone. Dashed line at 0 represents no difference from lurasidone

Fig. 3

Comparison of CGI-S score improvement for lurasidone relative to comparators. CGI-S Clinical Global Impressions-Severity Scale. *Statistically significant compared to lurasidone. Dashed line at 0 represents no difference from lurasidone

Fig. 4

Comparison of change in body weight (kg) for lurasidone relative to comparators. *Statistically significant compared to lurasidone. Dashed line at 0 represents no difference from lurasidone

Fig. 5

Comparisons of all-cause discontinuation for lurasidone relative to comparators. *Statistically significant compared to lurasidone. Dashed line at 1 represents no difference from lurasidone

Fig. 6

Comparison of extrapyramidal symptoms for lurasidone relative to comparators. *Statistically significant compared to lurasidone. Dashed line at 1 represents no difference from lurasidone

Fig. 7

Comparison of Akathisia for lurasidone relative to comparators. *Statistically significant compared to lurasidone. Dashed line at 1 represents no difference from lurasidone