Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Centre for Mental Disorders (Peking University Sixth Hospital), Beijing, PR China.
Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha, PR China.
J Psychopharmacol. 2019 Oct;33(10):1227-1236. doi: 10.1177/0269881119872193. Epub 2019 Sep 5.
This study aimed to investigate the efficacy and tolerability of aripiprazole, olanzapine and risperidone in first-episode schizophrenia (FES).
The eight-week, open, randomised study was conducted in six Chinese medical centres. Altogether, 498 FES subjects were randomised to aripiprazole ( = 165), olanzapine ( = 168) or risperidone ( = 165). Efficacy was measured with the Positive and Negative Syndrome Scale (PANSS), tolerability with the Udvalg for Kliniske Undersogelser Side Effect Rating Scale (UKU) and functioning with the Personal and Social Performance Scale (PSP).
All three antipsychotics significantly improved the baseline to end-point PANSS total and each of the sub-scale scores ( < 0.001). Risperidone was superior to olanzapine and aripiprazole regarding PANSS total end-point scores ( < 0.05). Cumulative response (PANSS total score reduction ⩾30%) was similar between risperidone, olanzapine and aripiprazole (74.8%, 73.5% and 70.1%; = 0.707), but risperidone was superior to aripiprazole regarding PANSS total score reduction ⩾50% (37.8% vs. 26.6%; < 0.05). Olanzapine was associated with the largest weight gain at week 4 and 8 ( < 0.01), weight gain ⩾7% (olanzapine = 49.0% vs. risperidone = 32.5% vs. aripiprazole = 17.0%; < 0.01), more psychic side effects at week 8 ( < 0.01 each) and more 'other' side effects at week 4 ( < 0.001) and week 8 ( < 0.05) but fewer neurological side effects at week 4 ( < 0.05) and week 8 ( < 0.01). PSP improved more with risperidone than with aripiprazole at week 4 and 8 ( < 0.05).
For FES, risperidone might be a better choice than aripiprazole due to improved efficacy and functional improvement, without inferior tolerability. Aripiprazole is a better choice to avoid relevant short-term weight gain. Olanzapine could be chosen to avoid neurological adverse effects.
本研究旨在探讨阿立哌唑、奥氮平和利培酮治疗首发精神分裂症（FES）的疗效和耐受性。
这是一项在中国 6 家医疗中心开展的为期 8 周、开放、随机的研究。共纳入 498 例 FES 受试者，随机分为阿立哌唑（n=165）、奥氮平（n=168）或利培酮（n=165）组。采用阳性和阴性症状量表（PANSS）评估疗效，采用 Udvalg for Kliniske Undersogelser 副作用评定量表（UKU）评估耐受性，采用个人和社会功能量表（PSP）评估功能。
三种抗精神病药物均显著改善了基线至终点 PANSS 总分和各亚量表评分（均<0.001）。利培酮在 PANSS 总分终点评分方面优于奥氮平和阿立哌唑（<0.05）。利培酮、奥氮平和阿立哌唑的累积反应（PANSS 总分降低≥30%）相似（74.8%、73.5%和 70.1%；=0.707），但利培酮在 PANSS 总分降低≥50%方面优于阿立哌唑（37.8%比 26.6%；<0.05）。奥氮平在第 4 周和第 8 周时体重增加最大（均<0.01），体重增加≥7%（奥氮平=49.0%，利培酮=32.5%，阿立哌唑=17.0%；均<0.01），第 8 周时精神副作用更多（均<0.01），第 4 周和第 8 周时“其他”副作用更多（均<0.001），第 4 周和第 8 周时神经副作用更少（均<0.05）。第 4 周和第 8 周时，利培酮组 PSP 改善程度优于阿立哌唑组（均<0.05）。
对于 FES，利培酮可能是优于阿立哌唑的选择，因为其疗效和功能改善更优，而耐受性无劣于后者。为避免相关的短期体重增加，阿立哌唑是更好的选择。为避免神经不良反应，奥氮平可能是更好的选择。
