Ribeiro Esther Letícia Amorim, de Mendonça Lima Tácio, Vieira Marcio Eduardo Bergamini, Storpirtis Sílvia, Aguiar Patricia Melo
Department of Pharmacy, Faculty of Pharmaceutical Sciences, University of Sao Paulo, Av. Prof. Lineu Prestes, 580 - Conj. das Químicas - Bloco 13 - Cidade Universitária Butantã, Sao Paulo, Brazil.
Psychiatry Clinic, University Hospital of University Sao Paulo, Sao Paulo, Brazil.
Eur J Clin Pharmacol. 2018 Oct;74(10):1215-1233. doi: 10.1007/s00228-018-2498-1. Epub 2018 Jun 15.
To conduct an overview to summarize the efficacy and safety of aripiprazole for the treatment of schizophrenia.
A literature search was performed in PubMed, the Cochrane Library, LILACS, and the Centre for Reviews and Dissemination, for articles published until March 31, 2017. We included systematic reviews with meta-analyses of randomized controlled trials assessing the efficacy, and/or the safety of aripiprazole, for patients with schizophrenia. Two authors independently performed the study selection, data extraction, and quality assessment. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and the Risk of Bias in Systematic Review (ROBIS) tool were used to appraise the quality of evidence and the risk of bias in the reviews, respectively.
Fourteen studies fulfilled the inclusion criteria. Aripiprazole showed efficacy similar to that of both typical and atypical antipsychotic drugs (except olanzapine and amisulpride). Aripiprazole caused significantly lower weight gain and alterations in glucose and cholesterol levels, as compared to clozapine, risperidone, and olanzapine. In addition, aripiprazole caused significantly fewer general extrapyramidal side effects, less use of antiparkinsonian drugs, and akathisia, compared with typical antipsychotic drugs and risperidone. The overall quality of evidence in the reviews ranged from "very low" to "moderate," principally because of the risk of bias of original trials, inconsistency, and imprecision in the outcomes. According to the ROBIS tool, there are four reviews with "high" risk of bias and five with "unclear" risk of bias.
Aripiprazole exhibited efficacy similar to that of other antipsychotic drugs and a better safety profile than that of typical (i.e., less some extrapyramidal side effects) and atypical (i.e., less metabolic changes) antipsychotic drugs.
进行一项综述，总结阿立哌唑治疗精神分裂症的疗效和安全性。
在PubMed、Cochrane图书馆、LILACS以及综述与传播中心进行文献检索，检索截至2017年3月31日发表的文章。我们纳入了对评估阿立哌唑治疗精神分裂症患者疗效和/或安全性的随机对照试验进行荟萃分析的系统评价。两位作者独立进行研究选择、数据提取和质量评估。分别使用推荐评估、制定和评价分级（GRADE）方法以及系统评价中的偏倚风险（ROBIS）工具来评估证据质量和评价中的偏倚风险。
14项研究符合纳入标准。阿立哌唑显示出与典型和非典型抗精神病药物（奥氮平和氨磺必利除外）相似的疗效。与氯氮平、利培酮和奥氮平相比，阿立哌唑导致的体重增加以及血糖和胆固醇水平变化显著更低。此外，与典型抗精神病药物和利培酮相比，阿立哌唑引起的一般性锥体外系副作用明显更少，抗帕金森药物的使用更少，静坐不能也更少。综述中的证据总体质量从“极低”到“中等”不等，主要是因为原始试验存在偏倚风险、结果不一致以及不精确。根据ROBIS工具，有4项评价存在“高”偏倚风险，5项存在“不清楚”偏倚风险。
阿立哌唑表现出与其他抗精神病药物相似的疗效，并且比典型（即某些锥体外系副作用较少）和非典型（即代谢变化较少）抗精神病药物具有更好的安全性。
