Abstract
Background: Numerous case reports have reported psychotic worsening when switching to or adding aripiprazole in patients with schizophrenia. The risk of psychotic worsening related to aripiprazole was evaluated through a systematic review and meta-analysis. Data Sources: MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were systematically searched using the following keywords: (schizophr∗ or schizoaff∗) AND aripiprazole, with a limitation of randomized controlled trial and English language (last search: September 9, 2016) by the authors in an independent fashion. Study Selection: Double-blind, randomized, controlled trials involving a switch to or addition of aripiprazole in schizophrenia spectrum disorders were selected by the authors in an independent fashion. A total of 22 studies (13 switching and 9 adding studies) involving 5,769 patients that met eligibility criteria were identified and included in the meta-analysis. Data Extraction: Number of patients who experienced psychotic worsening, agitation, or anxiety as well as those who discontinued the study due to all causes, lack of efficacy, or adverse events were extracted. Results: Psychotic worsening was reported as an adverse event in all studies. No significant difference in the risk of psychotic worsening was found between switching to aripiprazole and switching to another antipsychotic (RR = 1.17, 95% CI = 0.97-1.42, P =.10); however, switching to aripiprazole was related to a significantly greater risk of study discontinuation due to lack of efficacy (RR = 1.46, 95% CI = 1.10-1.93, P =.009). Lack of data resulted in no conclusive results as to clinical risks of adding aripiprazole. Conclusions: Findings suggest that there is no direct evidence that a switch to aripiprazole is related to risk of psychotic worsening in participants in clinical trials, although a switch to aripiprazole may be associated with a higher risk of study discontinuation due to lack of efficacy.
| Original language | English |
|---|---|
| Article number | 17r11489 |
| Journal | Journal of Clinical Psychiatry |
| Volume | 79 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - 2018 Mar 1 |
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ASJC Scopus subject areas
- Psychiatry and Mental health
Cite this
Can aripiprazole worsen psychosis in schizophrenia? a meta-analysis of double-blind, randomized, controlled trials. / Takeuchi, Hiroyoshi; Fathi, Ali; Thiyanavadivel, Sadhana; Agid, Ofer; Remington, Gary.
In: Journal of Clinical Psychiatry, Vol. 79, No. 2, 17r11489, 01.03.2018.Research output: Contribution to journal › Article
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TY - JOUR
T1 - Can aripiprazole worsen psychosis in schizophrenia? a meta-analysis of double-blind, randomized, controlled trials
AU - Takeuchi, Hiroyoshi
AU - Fathi, Ali
AU - Thiyanavadivel, Sadhana
AU - Agid, Ofer
AU - Remington, Gary
PY - 2018/3/1
Y1 - 2018/3/1
N2 - Background: Numerous case reports have reported psychotic worsening when switching to or adding aripiprazole in patients with schizophrenia. The risk of psychotic worsening related to aripiprazole was evaluated through a systematic review and meta-analysis. Data Sources: MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were systematically searched using the following keywords: (schizophr∗ or schizoaff∗) AND aripiprazole, with a limitation of randomized controlled trial and English language (last search: September 9, 2016) by the authors in an independent fashion. Study Selection: Double-blind, randomized, controlled trials involving a switch to or addition of aripiprazole in schizophrenia spectrum disorders were selected by the authors in an independent fashion. A total of 22 studies (13 switching and 9 adding studies) involving 5,769 patients that met eligibility criteria were identified and included in the meta-analysis. Data Extraction: Number of patients who experienced psychotic worsening, agitation, or anxiety as well as those who discontinued the study due to all causes, lack of efficacy, or adverse events were extracted. Results: Psychotic worsening was reported as an adverse event in all studies. No significant difference in the risk of psychotic worsening was found between switching to aripiprazole and switching to another antipsychotic (RR = 1.17, 95% CI = 0.97-1.42, P =.10); however, switching to aripiprazole was related to a significantly greater risk of study discontinuation due to lack of efficacy (RR = 1.46, 95% CI = 1.10-1.93, P =.009). Lack of data resulted in no conclusive results as to clinical risks of adding aripiprazole. Conclusions: Findings suggest that there is no direct evidence that a switch to aripiprazole is related to risk of psychotic worsening in participants in clinical trials, although a switch to aripiprazole may be associated with a higher risk of study discontinuation due to lack of efficacy.
AB - Background: Numerous case reports have reported psychotic worsening when switching to or adding aripiprazole in patients with schizophrenia. The risk of psychotic worsening related to aripiprazole was evaluated through a systematic review and meta-analysis. Data Sources: MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were systematically searched using the following keywords: (schizophr∗ or schizoaff∗) AND aripiprazole, with a limitation of randomized controlled trial and English language (last search: September 9, 2016) by the authors in an independent fashion. Study Selection: Double-blind, randomized, controlled trials involving a switch to or addition of aripiprazole in schizophrenia spectrum disorders were selected by the authors in an independent fashion. A total of 22 studies (13 switching and 9 adding studies) involving 5,769 patients that met eligibility criteria were identified and included in the meta-analysis. Data Extraction: Number of patients who experienced psychotic worsening, agitation, or anxiety as well as those who discontinued the study due to all causes, lack of efficacy, or adverse events were extracted. Results: Psychotic worsening was reported as an adverse event in all studies. No significant difference in the risk of psychotic worsening was found between switching to aripiprazole and switching to another antipsychotic (RR = 1.17, 95% CI = 0.97-1.42, P =.10); however, switching to aripiprazole was related to a significantly greater risk of study discontinuation due to lack of efficacy (RR = 1.46, 95% CI = 1.10-1.93, P =.009). Lack of data resulted in no conclusive results as to clinical risks of adding aripiprazole. Conclusions: Findings suggest that there is no direct evidence that a switch to aripiprazole is related to risk of psychotic worsening in participants in clinical trials, although a switch to aripiprazole may be associated with a higher risk of study discontinuation due to lack of efficacy.
UR - http://www.scopus.com/inward/record.url?scp=85046902616&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85046902616&partnerID=8YFLogxK
U2 - 10.4088/JCP.17r11489
DO - 10.4088/JCP.17r11489
M3 - Article
C2 - 29570965
AN - SCOPUS:85046902616
VL - 79
JO - Journal of Clinical Psychiatry
JF - Journal of Clinical Psychiatry
SN - 0160-6689
IS - 2
M1 - 17r11489
ER -