Adjunctive aripiprazole for antipsychotic-related hyperprolactinaemia in patients with first-episode schizophrenia: a meta-analysis. Issue 5 (17th October 2019)

• Record Type: Journal Article
• Authors: Zheng, Wei; Cai, Dong-Bin; Yang, Xin-Hu; Zheng, Wei; Ungvari, Gabor S; Ng, Chee H; Shi, Zhan-Ming; Hu, Mei-Ling; Ning, Yu-Ping; Xiang, Yu-Tao
• Is Part Of: General psychiatry. Volume 32:Issue 5(2019)
• Publication Date: 2019-10-17
• Subjects: prolactin -- aripiprazole -- schizophrenia -- first episode -- meta-analysis; Psychiatry -- Periodicals; 616.89
• DOI: 10.1136/gpsych-2019-100091
• Languages: English
• ISSNs: 2096-5923

Abstract

Abstract : Background: Hyperprolactinaemia is a common antipsychotic (AP)-induced adverse effect, particularly in female patients. Aims: This meta-analysis examined the efficacy and safety of adjunctive aripiprazole in preventing AP-related hyperprolactinaemia in patients with first-episode schizophrenia. Methods: PubMed, PsycINFO, EMBASE, Cochrane Library, WanFang and China Journal Net databases were searched to identify eligible randomised controlled trials (RCTs). Primary outcomes were the reductions of serum prolactin level and prolactin-related symptoms. Data were independently extracted by two reviewers and analysed using RevMan (V.5.3). Weighted/standardised mean differences (WMDs/SMDs)±95% CIs were reported. Results: In the five RCTs (n=400), the adjunctive aripiprazole (n=197) and the control groups (n=203) with a mean of 11.2 weeks of treatment duration were compared. The aripiprazole group had a significantly lower endpoint serum prolactin level in all patients (five RCTs, n=385; WMD: −50.43 ng/mL (95% CI: −75.05 to −25.81), p<0.00001; I 2 =99%), female patients (two RCTs, n=186; WMD: −22.58 ng/mL (95% CI: −25.67 to −19.49), p<0.00001; I 2 =0%) and male patients (two RCTs, n=127; WMD: −68.80 ng/mL (95% CI: −100.11 to −37.49), p<0.0001). In the sensitivity analysis for the endpoint serum prolactin level in all patients, the findings remained significant (p<0.00001; I 2 =96%). The aripiprazole group was superior to the control group in improving negative symptoms as assessed by the Positive and Negative Syndrome Scale (three RCTs, n=213; SMD: −0.51 (95% CI: −0.79 to −0.24), p=0.0002; I 2 =0%). Adverse effects and discontinuation rates were similar between the two groups. Conclusions: Adjunctive aripiprazole appears to be associated with reduced AP-induced hyperprolactinaemia and improved prolactin-related symptoms in first-episode schizophrenia. Further studies with large sample sizes are needed to confirm these findings.