Phalguni Angaja, McCool Rachael, Wood Hannah, Sanderson Alice, Rydevik Gustaf, Franklin Brooke, James Daniel
York Health Economics Consortium, Enterprise House, University of York, Heslington, York.
Quantics, Exchange Tower, Edinburgh, UK.
Int Clin Psychopharmacol. 2023 Jan 1;38(1):45-56. doi: 10.1097/YIC.0000000000000427. Epub 2022 Jul 22.
A systematic review was undertaken to identify randomized controlled trials (RCTs) comparing the efficacy and safety of lurasidone, brexpiprazole and cariprazine (selected because of a shared safety profile) with each other or placebo in adult patients with schizophrenia. Key outcomes included: Positive and Negative Syndrome Scales (PANSS), Clinical Global Impression-Severity (CGI-S) scores and cardiovascular and metabolic parameters. A feasibility assessment evaluated the trials' suitability for inclusion in a Bayesian network meta-analysis (NMA). Random effects models were used. In total, 1138 records were identified and 19 RCTs contributed to the NMA. Lurasidone doses of 160 mg performed best in terms of change in PANSS and CGI-S scores at 6 weeks, with stronger evidence when compared with brexpiprazole than cariprazine. The safety outcomes were variable; for all treatments, the 95% credible intervals usually contained 'no difference'. Active treatments were associated with lower odds of discontinuation due to any cause, and higher odds of experiencing any adverse event. Lurasidone was comparable to brexpiprazole and cariprazine for efficacy and safety outcomes assessed at 6 weeks, with the 160 mg dose being superior for the change in PANSS and CGI-S outcomes. The lurasidone results were relatively consistent across doses compared with brexpiprazole and cariprazine.
开展了一项系统评价，以确定比较鲁拉西酮、布瑞哌唑和卡立普唑（因其具有共同的安全性特征而被选中）与安慰剂在成年精神分裂症患者中的疗效和安全性的随机对照试验（RCT）。主要结局包括：阳性和阴性症状量表（PANSS）、临床总体印象-严重程度（CGI-S）评分以及心血管和代谢参数。进行了可行性评估，以评价这些试验是否适合纳入贝叶斯网络荟萃分析（NMA）。采用随机效应模型。总共识别出1138条记录，19项RCT纳入了NMA。在6周时，160mg剂量的鲁拉西酮在PANSS和CGI-S评分变化方面表现最佳，与布瑞哌唑相比，与卡立普唑相比有更强的证据。安全性结局存在差异；对于所有治疗，95%可信区间通常包含“无差异”。活性治疗与因任何原因停药的较低几率以及发生任何不良事件的较高几率相关。在6周时评估的疗效和安全性结局方面，鲁拉西酮与布瑞哌唑和卡立普唑相当，160mg剂量在PANSS和CGI-S结局变化方面更优。与布瑞哌唑和卡立普唑相比，鲁拉西酮各剂量的结果相对一致。
