Komossa Katja, Rummel-Kluge Christine, Schmid Franziska, Hunger Heike, Schwarz Sandra, El-Sayeh Hany George G, Kissling Werner, Leucht Stefan
Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München Klinikum rechts der Isar, Moehlstrasse 26, München, Germany, 81675.
Cochrane Database Syst Rev. 2009 Oct 7(4):CD006569. doi: 10.1002/14651858.CD006569.pub3.
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.
To evaluate the effects of aripiprazole compared with other atypical antipsychotics for people with schizophrenia and schizophrenia-like psychoses.
We searched the Cochrane Schizophrenia Group Trials Register (March 2007) which is based on regular searches of BIOSIS, CENTRAL, CINAHL, EMBASE, MEDLINE and PsycINFO.
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.
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.
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.
在许多工业化国家，第二代（非典型）抗精神病药物已成为精神分裂症患者的一线药物治疗。各种第二代抗精神病药物的效果是否存在差异以及差异程度如何，这是一个有争议的问题。在本综述中，我们研究阿立哌唑的疗效和耐受性与其他第二代抗精神病药物有何不同。
评估阿立哌唑与其他非典型抗精神病药物相比，对精神分裂症和类精神分裂症精神病患者的疗效。
我们检索了Cochrane精神分裂症研究组试验注册库（2007年3月），该注册库基于对BIOSIS、CENTRAL、CINAHL、EMBASE、MEDLINE和PsycINFO的定期检索。
我们纳入了所有将口服阿立哌唑与口服氨磺必利、氯氮平、奥氮平、喹硫平、利培酮、舍吲哚、齐拉西酮或佐替平用于精神分裂症或类精神分裂症精神病患者的随机试验。
我们独立提取数据。对于二分数据，我们基于意向性分析，采用随机效应模型计算相对风险（RR）及其95%置信区间（CI）。在适当情况下，我们计算治疗所需人数/伤害所需人数（NNT/NNH）。对于连续数据，我们同样基于随机效应模型计算加权平均差（MD）。
本综述目前包括四项试验，共1404名参与者，涉及八项可能比较中的两项——阿立哌唑与奥氮平以及阿立哌唑与利培酮。提前退出研究的参与者总数相当可观（38.5%），这限制了研究结果的有效性，但两组之间无显著差异。就总体精神状态而言，阿立哌唑的疗效不如奥氮平（阳性和阴性症状量表总分：n = 794，2项随机对照试验，MD 4.96，CI 1.85至8.06），但它与较少的副作用相关，如胆固醇升高、体重增加、镇静作用以及与催乳素相关的副作用。与利培酮相比，疗效无差异（阳性和阴性症状量表总分：n = 372，2项随机对照试验，MD 1.50，CI -2.96至5.96）。阿立哌唑组的肌张力障碍、QTc异常、催乳素和胆固醇升高的发生率较低，而与分配接受利培酮治疗的组相比，阿立哌唑组震颤更频繁。
阿立哌唑的疗效可能比奥氮平稍差，但在代谢影响和镇静方面耐受性更好。与利培酮相比，没有证据表明疗效存在差异，但在肌张力障碍、胆固醇、催乳素升高和QTc延长方面耐受性更好。目前尚无比较阿立哌唑与其他第二代抗精神病药物的随机证据。
