Muneer Muneeb Ahmad, Habiba Ume, Shehzad Shajjia, Batool Washija, Shah Dawood, Shahzad Zain, Kirmani Muhammad Khizar, Siddiqui Zohaib Hassan, Amjad Areeb, Hamza Ameer, Khan Muhammad Faizan, Butt Fahad Siddique, Haider Syed Tehseen
Allama Iqbal Medical College, Lahore, Pakistan.
Jinnah Sindh Medical University, Karachi, Pakistan.
Acta Neurol Belg. 2025 Aug 12. doi: 10.1007/s13760-025-02864-2.
Tourette Syndrome (TS) is a neurodevelopmental disorder characterized by involuntary motor and vocal tics, typically manifesting in childhood. Pharmacological interventions play a crucial role in symptom management, yet the comparative efficacy of the most important agents remain underexplored.
To evaluate and compare the efficacy of aripiprazole and valbenazine in the treatment of TS through a systematic review and meta-analysis of randomized controlled trials (RCTs).
A systematic search of PubMed, Embase, Scopus, and ClinicalTrials.gov was conducted up to March 30, 2025. Eligible RCTs included participants aged 6 to 65 years with a clinical diagnosis of TS, comparing aripiprazole or valbenazine to placebo. The primary outcomes were changes in the Yale Global Tic Severity Scale-Total Tic Score (YGTSS-TTS) and Clinical Global Impression of Tourette Syndrome (CGI-TS). Data were analyzed using random-effects models with assessment of heterogeneity.
Eight RCTs involving 626 participants were included. Aripiprazole significantly reduced tic severity (YGTSS-TTS: mean difference [MD] = - 5.96; 95% CI: -9.59 to - 2.33; p < 0.001) and improved global functioning (CGI-TS: MD = - 0.56; 95% CI: -1.10 to - 0.02; p < 0.001), with low heterogeneity. Valbenazine demonstrated a significant trend toward tic reduction (YGTSS-TTS: MD = - 1.93; 95% CI: -2.94 to -0.93; p < 0.001) and significantly improved CGI-TS scores (MD = - 0.36; 95% CI: -0.69 to - 0.02; p < 0.001), though the effects were less pronounced than with aripiprazole.
This meta-analysis indicates that aripiprazole is more effective than valbenazine in reducing tic severity and improving overall clinical outcomes in individuals with TS. While both agents demonstrated statistically significant benefits over placebo, aripiprazole yielded a greater magnitude of improvement with consistent results across studies. These findings support the continued use of aripiprazole as a first-line pharmacologic option, while highlighting valbenazine as a potential alternative in select cases. Further high-quality trials are warranted to clarify the role of valbenazine and optimize individualized treatment strategies for TS.
抽动秽语综合征（TS）是一种神经发育障碍，其特征为不自主的运动和发声抽动，通常在儿童期出现。药物干预在症状管理中起着关键作用，但最重要药物的比较疗效仍未得到充分探索。
通过对随机对照试验（RCT）进行系统评价和荟萃分析，评估并比较阿立哌唑和缬苯那嗪治疗TS的疗效。
截至2025年3月30日，对PubMed、Embase、Scopus和ClinicalTrials.gov进行了系统检索。符合条件的RCT纳入了年龄在6至65岁、临床诊断为TS的参与者，将阿立哌唑或缬苯那嗪与安慰剂进行比较。主要结局指标为耶鲁全球抽动严重程度量表-总抽动评分（YGTSS-TTS）和抽动秽语综合征临床总体印象（CGI-TS）的变化。使用随机效应模型分析数据并评估异质性。
纳入了8项涉及626名参与者的RCT。阿立哌唑显著降低了抽动严重程度（YGTSS-TTS：平均差[MD]= -5.96；95%可信区间：-9.59至-2.33；p<0.001），并改善了整体功能（CGI-TS：MD= -0.56；95%可信区间：-1.10至-0.02；p<0.001），异质性较低。缬苯那嗪显示出抽动减少的显著趋势（YGTSS-TTS：MD= -1.93；95%可信区间：-2.94至-0.93；p<0.001），且CGI-TS评分显著改善（MD= -0.36；95%可信区间：-0.69至-0.02；p<0.001），尽管其效果不如阿立哌唑明显。
这项荟萃分析表明，在降低TS患者的抽动严重程度和改善总体临床结局方面，阿立哌唑比缬苯那嗪更有效。虽然两种药物与安慰剂相比均显示出统计学上的显著益处，但阿立哌唑改善程度更大，且各研究结果一致。这些发现支持继续将阿立哌唑作为一线药物选择，同时强调缬苯那嗪在某些情况下作为潜在替代药物的作用。需要进一步开展高质量试验，以阐明缬苯那嗪的作用，并优化TS的个体化治疗策略。
