Schizophrenia Division, Complex Care & Recovery Program, Centre for Addiction and Mental Health, 250 College St, Toronto, Ontario M5T 1R8, Canada.
Schizophrenia Division, Complex Care & Recovery Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
J Clin Psychiatry. 2018 Mar/Apr;79(2). doi: 10.4088/JCP.17r11489.
Numerous case reports have reported psychotic worsening when switching to or adding aripiprazole in patients with schizophrenia. The risk of psychotic worsening related to aripiprazole was evaluated through a systematic review and meta-analysis.
MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were systematically searched using the following keywords: (schizophr* or schizoaff*) AND aripiprazole, with a limitation of randomized controlled trial and English language (last search: September 9, 2016) by the authors in an independent fashion.
Double-blind, randomized, controlled trials involving a switch to or addition of aripiprazole in schizophrenia spectrum disorders were selected by the authors in an independent fashion. A total of 22 studies (13 switching and 9 adding studies) involving 5,769 patients that met eligibility criteria were identified and included in the meta-analysis.
Number of patients who experienced psychotic worsening, agitation, or anxiety as well as those who discontinued the study due to all causes, lack of efficacy, or adverse events were extracted.
Psychotic worsening was reported as an adverse event in all studies. No significant difference in the risk of psychotic worsening was found between switching to aripiprazole and switching to another antipsychotic (RR = 1.17, 95% CI = 0.97-1.42, P = .10); however, switching to aripiprazole was related to a significantly greater risk of study discontinuation due to lack of efficacy (RR = 1.46, 95% CI = 1.10-1.93, P = .009). Lack of data resulted in no conclusive results as to clinical risks of adding aripiprazole.
Findings suggest that there is no direct evidence that a switch to aripiprazole is related to risk of psychotic worsening in participants in clinical trials, although a switch to aripiprazole may be associated with a higher risk of study discontinuation due to lack of efficacy.
大量病例报告显示，精神分裂症患者在转换或加用阿立哌唑时会出现精神病恶化。本系统评价和荟萃分析评估了与阿立哌唑相关的精神病恶化风险。
作者独立地通过以下关键词在 MEDLINE、Embase 和 Cochrane 对照试验中心注册库中进行了系统搜索：(schizophr* 或 schizoaff*) AND aripiprazole，限制为随机对照试验和英语语言（最后一次搜索：2016 年 9 月 9 日）。
作者独立地选择了涉及精神分裂症谱系障碍中转换或加用阿立哌唑的双盲、随机、对照试验。共有 22 项研究（13 项转换研究和 9 项加用研究）符合纳入标准，共纳入 5769 例患者进行荟萃分析。
提取出现精神病恶化、激越或焦虑的患者人数以及因所有原因、疗效不佳或不良事件而退出研究的患者人数。
所有研究均报告精神病恶化是一种不良事件。转换用阿立哌唑与转换用其他抗精神病药相比，精神病恶化风险无显著差异（RR=1.17，95%CI=0.97-1.42，P=0.10）；然而，转换用阿立哌唑与因疗效不佳而停药的风险显著增加（RR=1.46，95%CI=1.10-1.93，P=0.009）。由于缺乏数据，无法得出关于加用阿立哌唑的临床风险的明确结论。
研究结果表明，没有直接证据表明转换用阿立哌唑与临床试验参与者的精神病恶化风险相关，尽管转换用阿立哌唑可能与因疗效不佳而停药的风险增加有关。
