Institute of Mental Health, Peking University Sixth Hospital, Beijing, 100191, China.
National Clinical Research Center for Mental Disorders, (Peking University Sixth Hospital), Beijing, 100191, China.
Transl Psychiatry. 2022 Jul 5;12(1):267. doi: 10.1038/s41398-022-02027-4.
Antipsychotic-induced hyperprolactinemia (AP-induced HPRL) occurs overall in up to 70% of patients with schizophrenia, which is associated with hypogonadism and sexual dysfunction. We summarized the latest evidence for the benefits of prolactin-lowering drugs. We performed network meta-analyses to summarize the evidence and applied Grading of Recommendations Assessment, Development, and Evaluation frameworks (GRADE) to rate the certainty of evidence, categorize interventions, and present the findings. The search identified 3,022 citations, 31 studies of which with 1999 participants were included in network meta-analysis. All options were not significantly better than placebo among patients with prolactin (PRL) less than 50 ng/ml. However, adjunctive aripiprazole (ARI) (5 mg: MD = -64.26, 95% CI = -87.00 to -41.37; 10 mg: MD = -59.81, 95% CI = -90.10 to -29.76; more than 10 mg: MD = -68.01, 95% CI = -97.12 to -39.72), switching to ARI in titration (MD = -74.80, 95% CI = -134.22 to -15.99) and adjunctive vitamin B6 (MD = -91.84, 95% CI = -165.31 to -17.74) were associated with significant decrease in AP-induced PRL among patients with PRL more than 50 ng/ml with moderated (adjunctive vitamin B6) to high (adjunctive ARI) certainty of evidence. Pharmacological treatment strategies for AP-induced HPRL depends on initial PRL level. No effective strategy was found for patients with AP-induced HPRL less than 50 ng/ml, while adjunctive ARI, switching to ARI in titration and adjunctive high-dose vitamin B6 showed better PRL decrease effect on AP-induced HPRL more than 50 ng/ml.
抗精神病药引起的高催乳素血症（AP 引起的 HPRL）总体上发生在高达 70%的精神分裂症患者中，与性腺功能减退和性功能障碍有关。我们总结了降低催乳素药物的最新证据。我们进行了网络荟萃分析，以总结证据，并应用推荐评估、制定和评估框架（GRADE）来评估证据的确定性、分类干预措施并呈现结果。搜索确定了 3022 条引文，其中 31 项研究共纳入 1999 名参与者进行网络荟萃分析。在催乳素（PRL）低于 50ng/ml 的患者中，所有选择与安慰剂相比均无明显优势。然而，阿立哌唑（ARI）的附加治疗（5mg：MD=-64.26，95%CI=-87.00 至-41.37；10mg：MD=-59.81，95%CI=-90.10 至-29.76；超过 10mg：MD=-68.01，95%CI=-97.12 至-39.72）、滴定时转换为 ARI（MD=-74.80，95%CI=-134.22 至-15.99）和附加维生素 B6（MD=-91.84，95%CI=-165.31 至-17.74）与 PRL 大于 50ng/ml 的患者中 AP 诱导的 PRL 显著降低相关，证据确定性适中（附加维生素 B6）到高（附加 ARI）。AP 引起的 HPRL 的药物治疗策略取决于初始 PRL 水平。在 PRL 小于 50ng/ml 的患者中，没有发现有效的治疗策略，而附加 ARI、滴定时转换为 ARI 和附加大剂量维生素 B6 对 PRL 大于 50ng/ml 的 AP 诱导的 HPRL 有更好的降低效果。
