Centre de Recherche Fernand Seguin, Hôpital L.-H. Lafontaine, Université de Montréal, Québec, Canada.
Clin Ther. 2010;32 Suppl 1:S3-20. doi: 10.1016/j.clinthera.2010.01.021.
During the past decade, there has been some progress in the pharmacotherapy of schizophrenia and schizoaffective disorder. Current evidence supports the use of various second-generation, or atypical, antipsychotic medications, although few of these agents have been associated with long-term efficacy and tolerability. Aripiprazole is an atypical antipsychotic that has been found to improve positive and negative symptoms of schizophrenia with a favorable adverse-effect profile.
This article reviews the efficacy and tolerability of aripiprazole in the context of recommended management strategies for schizophrenia and schizoaffective disorder, and in comparison with first-generation and other second-generation antipsychotics.
A search of MEDLINE (1999-May 2009) was conducted for reports of short- and long-term clinical studies of atypical antipsychotics (including aripiprazole) and meta-analyses of randomized controlled trials comparing first- and second-generation antipsychotics (including aripiprazole) in the treatment of schizophrenia or schizoaffective disorder. The search terms were schizophrenia; schizoaffective disorder; pharmacogenetics; adverse effects; tardive dyskinesia AND atypical antipsychotics; aripiprazole; aripiprazole, schizophrenia, AND double-blind studies; and atypical antipsychotics AND adverse effects. The reference lists of identified articles were reviewed for additional relevant publications. Only full study publications were included.
Based on the clinical evidence, including data from short-term (4-8 weeks) and long-term (26-52 weeks) randomized, double-blind clinical trials, aripiprazole has been associated with improvements in positive, negative, cognitive, and affective symptoms of schizophrenia and schizoaffective disorder. It has been associated with long-term (up to 52 weeks) symptom control in schizophrenia, as well as with efficacy in treatment-resistant schizophrenia. Common adverse effects associated with aripiprazole were nausea, insomnia, and agitation. These effects were usually transient. The evidence suggests that aripiprazole is unlikely to be associated with clinically significant weight gain or dyslipidemia, increased prolactin levels, or prolongation of the QTc interval. Compared with placebo, aripiprazole has been reported to have a relatively low potential for inducing metabolic syndrome.
Based on the evidence reviewed, aripiprazole monotherapy appears to be effective and well tolerated in treating the positive, negative, and cognitive symptoms of schizophrenia and schizoaffective disorder. It was associated with a low risk for the common adverse effects of antipsychotic therapy, including metabolic and endocrine alterations.
在过去的十年中，精神分裂症和分裂情感障碍的药物治疗取得了一些进展。目前的证据支持使用各种第二代，即非典型，抗精神病药物，尽管这些药物中的少数与长期疗效和耐受性相关。阿立哌唑是一种非典型抗精神病药，已被发现可改善精神分裂症的阳性和阴性症状，并具有有利的不良影响。
本文综述了阿立哌唑在精神分裂症和分裂情感障碍的推荐管理策略背景下的疗效和耐受性，并与第一代和其他第二代抗精神病药进行了比较。
对 MEDLINE（1999 年 5 月至 2009 年）进行了搜索，以查找短期和长期临床研究的报告，这些研究评估了非典型抗精神病药（包括阿立哌唑）的疗效和耐受性，以及比较了第一代和第二代抗精神病药（包括阿立哌唑）治疗精神分裂症或分裂情感障碍的随机对照试验的荟萃分析。搜索词为精神分裂症;分裂情感障碍;药物遗传学;不良反应;迟发性运动障碍和非典型抗精神病药;阿立哌唑;阿立哌唑，精神分裂症和双盲研究;和非典型抗精神病药和不良反应。对已确定文章的参考文献进行了审查，以寻找其他相关出版物。仅包括完整的研究出版物。
根据包括短期（4-8 周）和长期（26-52 周）随机，双盲临床试验数据在内的临床证据，阿立哌唑与精神分裂症和分裂情感障碍的阳性，阴性，认知和情感症状的改善相关。它与精神分裂症长达 52 周的症状控制以及治疗抵抗性精神分裂症的疗效相关。与阿立哌唑相关的常见不良反应包括恶心，失眠和激越。这些影响通常是短暂的。证据表明，阿立哌唑不太可能与临床上明显的体重增加或血脂异常，催乳素水平升高或 QTc 间期延长相关。与安慰剂相比，据报道，阿立哌唑具有相对较低的引发代谢综合征的潜力。
根据审查的证据，阿立哌唑单药治疗似乎可有效治疗精神分裂症和分裂情感障碍的阳性，阴性和认知症状，且耐受性良好。它与抗精神病治疗的常见不良反应（包括代谢和内分泌改变）的风险低相关。
