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

doi:10.1136/gpsych-2019-100091

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

Gen Psychiatr. 2019 Oct 17;32(5):e100091. doi: 10.1136/gpsych-2019-100091. eCollection 2019.

Authors

Wei Zheng^#^{1

2}, Dong-Bin Cai^#³, Xin-Hu Yang¹, Gabor S Ungvari^{4

5}, Chee H Ng⁶, Zhan-Ming Shi⁷, Mei-Ling Hu⁸, Yu-Ping Ning¹, Yu-Tao Xiang^{9

10}

Affiliations

¹ The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, China.
² School of Medicine, Xiamen University, Xiamen, China.
³ Shenzhen Traditional Chinese Medicine, Shenzhen, China.
⁴ University of Notre Dame Australia, Fremantle, Western Australia, Australia.
⁵ Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Western Australia, Australia.
⁶ Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia.
⁷ Chongqing Jiangbei Mental Health Center, Chongqing, China.
⁸ Shangrao Fifth People's Hospital, Shangrao, China.
⁹ Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China.
¹⁰ Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China.

^# Contributed equally.

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; I²=99%), female patients (two RCTs, n=186; WMD: -22.58 ng/mL (95% CI: -25.67 to -19.49), p<0.00001; I²=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; I²=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; I²=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.