Adjunctive aripiprazole for antipsychotic-related hyperprolactinaemia in patients with first-episode schizophrenia: A meta-analysis

Wei Zheng, Dong Bin Cai, Xin Hu Yang, Gabor S. Ungvari, Chee H. Ng, Zhan Ming Shi, Mei Ling Hu, Yu Ping Ning, Yu Tao Xiang

Research output: Contribution to journalArticle

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.

Original languageEnglish
Article numbere100091
JournalGeneral Psychiatry
Volume32
Issue number5
DOIs
Publication statusPublished - 1 Oct 2019

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Hyperprolactinemia
Antipsychotic Agents
Meta-Analysis
Schizophrenia
Prolactin
Randomized Controlled Trials
Serum
Control Groups
PubMed
Sample Size
Libraries
Aripiprazole
China
Databases
Safety

Cite this

Zheng, Wei ; Cai, Dong Bin ; Yang, Xin Hu ; Ungvari, Gabor S. ; Ng, Chee H. ; Shi, Zhan Ming ; Hu, Mei Ling ; Ning, Yu Ping ; Xiang, Yu Tao. / Adjunctive aripiprazole for antipsychotic-related hyperprolactinaemia in patients with first-episode schizophrenia : A meta-analysis. In: General Psychiatry. 2019 ; Vol. 32, No. 5.
@article{ab3c97f50b88487182494fd3db616bea,
title = "Adjunctive aripiprazole for antipsychotic-related hyperprolactinaemia in patients with first-episode schizophrenia: A meta-analysis",
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.",
keywords = "aripiprazole, first episode, meta-analysis, prolactin, schizophrenia",
author = "Wei Zheng and Cai, {Dong Bin} and Yang, {Xin Hu} and Ungvari, {Gabor S.} and Ng, {Chee H.} and Shi, {Zhan Ming} and Hu, {Mei Ling} and Ning, {Yu Ping} and Xiang, {Yu Tao}",
year = "2019",
month = "10",
day = "1",
doi = "10.1136/gpsych-2019-100091",
language = "English",
volume = "32",
journal = "General Psychiatry",
issn = "2096-5923",
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Adjunctive aripiprazole for antipsychotic-related hyperprolactinaemia in patients with first-episode schizophrenia : A meta-analysis. / Zheng, Wei; Cai, Dong Bin; Yang, Xin Hu; Ungvari, Gabor S.; Ng, Chee H.; Shi, Zhan Ming; Hu, Mei Ling; Ning, Yu Ping; Xiang, Yu Tao.

In: General Psychiatry, Vol. 32, No. 5, e100091, 01.10.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Adjunctive aripiprazole for antipsychotic-related hyperprolactinaemia in patients with first-episode schizophrenia

T2 - A meta-analysis

AU - Zheng, Wei

AU - Cai, Dong Bin

AU - Yang, Xin Hu

AU - Ungvari, Gabor S.

AU - Ng, Chee H.

AU - Shi, Zhan Ming

AU - Hu, Mei Ling

AU - Ning, Yu Ping

AU - Xiang, Yu Tao

PY - 2019/10/1

Y1 - 2019/10/1

N2 - 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.

AB - 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.

KW - aripiprazole

KW - first episode

KW - meta-analysis

KW - prolactin

KW - schizophrenia

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U2 - 10.1136/gpsych-2019-100091

DO - 10.1136/gpsych-2019-100091

M3 - Article

VL - 32

JO - General Psychiatry

JF - General Psychiatry

SN - 2096-5923

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