PEARLS No. 232, February 2009, written by Brian R McAvoy

Clinical question

How effective is aripiprazole compared with other atypical antipsychotics for people with schizophrenia and schizophrenia-like psychoses?  

Bottom line

On the basis of very limited data, aripiprazole was not as effective (in terms of general mental state) as olanzapine but was as effective as risperidone. Aripiprazole was associated with less weight gain, cholesterol increase and sedation, and fewer prolactinrelated effects than olanzapine. Compared to risperidone, aripiprazole produced fewer dystonias, cardiac arrhythmias, and prolactin and cholesterol increases. However, tremor was more frequent in the aripiprazole group compared to those allocated risperidone.

Caveat

The overall premature discontinuation rate of 38.5% was considerable, clearly limiting the validity of the results. Long term data (longer than 26 weeks) are not available. All of the four included studies were sponsored by the manufacturer of aripiprazole.  

Context

Schizophrenia is usually a chronic and disabling psychiatric disorder, which affects approximately 1 per cent of the population worldwide, with little gender difference. In many countries of the industrialised world, second generation (atypical) antipsychotics have become first-line drug treatments for people with schizophrenia. The question as to whether, and if so how much, the effects of the various second generation antipsychotics differ is a matter of debate.  

Cochrane Systematic Review

Komossa K et al. Aripiprazole versus other atypical antipschotics for schizophrenia. Cochrane Reviews 2009, Issue 4. Article No. CD006569. DOI: 10.1002/14651858. CD006569.pub2. This review contains 4 studies involving 1404 participants.