Table 2.
Comparisons of aripiprazole with D2R antagonists in the early course of schizophrenia.
| Outcomes | Studies (n) |
ARI (n) |
Other (n) |
Comparator antipsychotics | Effect estimatea | p | I2 |
|---|---|---|---|---|---|---|---|
| Overall symptomsb | 14 | 834 | 1255 | R, Q, O, Z, Pal, Per, H | −0.05 (−0.27 to 0.18)SMD | 0.69 | 80% |
| Short-term trials | 12 | 710 | 1067 | R, Q, O, Z, Pal, Per | 0.10 (−0.10 to 0.29) | 0.32 | 69% |
| Long-term trials | 7 | 427 | 606 | R, Q, O, Z, Pal, H | −0.30 (−0.68 to 0.08) | 0.12 | 86% |
| Positive symptoms | 9 | 586 | 901 | R, Q, O, Z, Pal, Per, H | −0.03 (−0.23 to 0.17)SMD | 0.79 | 63% |
| Short-term trials | 8 | 492 | 739 | R, Q, O, Z, Pal, Per | 0.02 (−0.16 to 0.20) | 0.82 | 50% |
| Long-term trials | 4 | 304 | 426 | R, Q, O, Z, Pal, H | −0.18 (−0.41 to 0.05) | 0.13 | 46% |
| Negative symptoms | 9 | 586 | 901 | R, Q, O, Z, Pal, Per, H | −0.00 (−0.15 to 0.15)SMD | 0.99 | 37% |
| Short-term trials | 8 | 492 | 739 | R, Q, O, Z, Pal, Per | 0.03 (−0.11 to 0.17) | 0.65 | 22% |
| Long-term trials | 4 | 304 | 426 | R, Q, O, Z, Pal, H | −0.16 (−0.32 to 0.00) | 0.06 | 0% |
| Depressive symptoms | 6 | 440 | 532 | R, Q, O, Z, Pal, H | −0.17 (−0.31 to −0.04)SMD | 0.01 | 0% |
| Short-term trials | 5 | 346 | 370 | R, Q, Z, Pal | −0.20 (−0.35 to −0.04) | 0.01 | 10% |
| Long-term trials | 3 | 280 | 376 | R, Q, O, Z, Pal, H | −0.17 (−0.35 to 0.01) | 0.06 | 8% |
| All-cause discontinuation | 11 | 1006 | 1495 | R, Q, O, Z, Pal, H | 0.92 (0.81 to 1.05)RR | 0.24 | 48% |
| Short-term trials | 9 | 650 | 1089 | R, Q, O, Z, Pal | 1.05 (0.76 to 1.45) | 0.78 | 70% |
| Long-term trials | 6 | 711 | 1049 | R, Q, O, Z, Pal, H | 0.88 (0.75 to 1.04) | 0.13 | 62% |
| Discontinuation due to adverse events | 8 | 891 | 1227 | R, Q, O, Z, Pal, H | 0.59 (0.33 to 1.07)RR | 0.08 | 65% |
| Short-term trials | 7 | 589 | 931 | R, Q, O, Z, Pal | 0.94 (0.59 to 1.50) | 0.81 | 6% |
| Long-term trials | 5 | 689 | 1027 | R, Q, O, Z, Pal, H | 0.40 (0.19 to 0.83) | 0.01c | 66% |
| Discontinuation due to inefficacy | 7 | 602 | 1111 | R, Q, O, Z, Pal, H | 1.64 (0.77 to 3.50)RR | 0.20 | 74% |
| Short-term trials | 6 | 483 | 828 | R, Q, O, Z, Pal | 1.20 (0.53 to 2.72) | 0.66 | 64% |
| Long-term trials | 4 | 452 | 904 | R, Q, O, Z, Pal, H | 1.48 (0.56 to 3.89) | 0.42 | 87% |
| Use of anticholinergics | 8 | 765 | 1048 | R, Q, O, Z, Pal, Per, H | 1.20 (0.87 to 1.65)RR | 0.26d | 74% |
| Short-term trials | 6 | 404 | 621 | R, Q, O, Z, Per | 1.45 (0.98 to 2.15) | 0.06 | 58% |
| Long-term trials | 4 | 453 | 584 | R, Q, O, Z, Pal, H | 1.09 (0.65 to 1.85) | 0.74 | 82% |
| Akathisia | 8 | 647 | 751 | R, Q, O, Z, Pal, Per, H | 1.24 (0.88 to 1.74)RR | 0.21d | 60% |
| Short-term trials | 6 | 373 | 636 | R, Q, O, Z, Per, H | 1.42 (1.05 to 1.90) | 0.02 | 39% |
| Long-term trials | 3 | 417 | 468 | R, Q, O, Z, Pal, H | 0.80 (0.54 to 1.17) | 0.25 | 28% |
| Weight gain | 8 | 809 | 1063 | R, Q, O, Z, Pal, Per, H | −0.11 (−0.47 to 0.25)SMD | 0.54 | 90% |
| Short-term trials | 7 | 574 | 806 | R, Q, O, Z, Pal, Per | −0.08 (−0.54 to 0.39) | 0.74 | 94% |
| Long-term trials | 4 | 488 | 599 | R, Q, O, Z, Pal, H | 0.12 (−0.42 to 0.67) | 0.65 | 91% |
| Total cholesterol | 7 | 447 | 591 | R, Q, O, Z, Pal, Per | −0.20 (−0.47 to 0.06)SMD | 0.14 | 70% |
| Short-term trials | 6 | 382 | 451 | R, Q, O, Z, Pal, Per | −0.28 (−0.49 to −0.06) | 0.01 | 56% |
| Long-term trials | 3 | 233 | 330 | Q, Z, Pal | 0.07 (−0.41 to 0.55) | 0.77 | 76% |
| Triglycerides | 7 | 448 | 590 | R, Q, O, Z, Pal, Per | −0.23 (−0.45 to −0.02)SMD | 0.03 | 55% |
| Short-term trials | 6 | 375 | 444 | R, Q, O, Z, Pal, Per | −0.27 (−0.42 to −0.11) | <0.001 | 18% |
| Long-term trials | 3 | 233 | 330 | Q, Z, Pal | −0.06 (−0.42 to 0.29) | 0.73 | 61% |
| Glucose | 7 | 449 | 595 | R, Q, O, Z, Pal, Per | −0.06 (−0.31 to 0.20)SMD | 0.66 | 69% |
| Short-term trials | 6 | 383 | 454 | R, Q, O, Z, Pal, Per | −0.22 (−0.35 to −0.08) | 0.002 | 0% |
| Long-term trials | 3 | 234 | 333 | Q, Z, Pal | 0.17 (−0.43 to 0.76) | 0.58 | 87% |
| Prolactin | 5 | 294 | 342 | R, Q, Z, Pal, Per | −0.55 (−0.94 to −0.16)SMD | 0.006 | 81% |
| Short-term trials | 5 | 295 | 339 | R, Q, Z, Pal, Per | −0.67 (−1.07 to −0.26) | 0.001 | 82% |
| Long-term trials | 2 | 146 | 186 | Q, Z, Pal | −0.52 (−1.17 to 0.12) | 0.11 | 88% |
| Sedation | 6 | 594 | 640 | R, Q, O, Z, Pal, Per, H | 0.91 (0.69 to 1.21)RR | 0.53 | 59% |
| Short-term trials | 4 | 249 | 274 | R, Q, Z, Per | 0.96 (0.71 to 1.30) | 0.79 | 47% |
| Long-term trials | 3 | 417 | 468 | R, Q, O, Z, Pal, H | 0.75 (0.57 to 0.99) | 0.04 | 0% |
D2R dopamine D2 receptor, EPS extrapyramidal symptoms, H haloperidol, O olanzapine, Pal paliperidone, Per perospirone, Q quetiapine, R risperidone, RR risk ratio, SMD standardized mean difference, Z ziprasidone.
aSMD less than 0 and RR less than 1 indicate aripiprazole is favored compared with other antipsychotics.
bBased on either the Positive and Negative Syndrome Scale or other validated scales (e.g., the Brief Psychiatric Rating Scale).
cNo longer significant after removing haloperidol.
dBecame significant (aripiprazole being less favorable) after removing haloperidol.