We extracted data independently. For dichotomous data we calculated risk ratios (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based on a random-effects model. Where possible, we calculated illustrative comparative risks for primary outcomes. For continuous data, we calculated mean differences (MD), again based on a random-effects model. We assessed risk of bias for each included study.
MAIN RESULTS: We included 12 trials involving 6389 patients.
Aripiprazole was compared to
olanzapine,
risperidone and
ziprasidone. All trials were sponsored by an interested drug manufacturer. The overall number of participants leaving studies early was 30% to 40%, limiting validity (no differences between groups).When compared with
olanzapine no differences were apparent for global state (no clinically important change: n = 703, 1 RCT, RR short-term 1.00 95% CI 0.81 to 1.22; n = 317, 1 RCT, RR medium-term 1.08 95% CI 0.95 to 1.22) but mental state tended to favour
olanzapine (n = 1360, 3 RCTs, MD total Positive and Negative Syndrome Scale (PANSS) 4.68 95% CI 2.21 to 7.16). There was no significant difference in extrapyramidal symptoms (n = 529, 2 RCTs, RR 0.99 95% CI 0.62 to 1.59) but fewer in the
aripiprazole group had increased
cholesterol levels (n = 223, 1 RCT, RR 0.32 95% CI 0.19 to 0.54) or
weight gain of 7% or more of total
body weight (n = 1095, 3 RCTs, RR 0.39 95% CI 0.28 to 0.54).When compared with
risperidone,
aripiprazole showed no advantage in terms of global state (n = 384, 2 RCTs, RR no important improvement 1.14 95% CI 0.81 to 1.60) or mental state (n = 372, 2 RCTs, MD total PANSS 1.50 95% CI -2.96 to 5.96).One study compared
aripiprazole with
ziprasidone (n = 247) and both the groups reported similar change in the global state (n = 247, 1 RCT, MD average change in Clinical Global Impression-Severity (CGI-S) score -0.03 95% CI -0.28 to 0.22) and mental state (n = 247, 1 RCT, MD change PANSS -3.00 95% CI -7.29 to 1.29).When compared with any one of several new generation
antipsychotic drugs the
aripiprazole group showed improvement in global state in energy (n = 523, 1 RCT, RR 0.69 95% CI 0.56 to 0.84), mood (n = 523, 1 RCT, RR 0.77 95% CI 0.65 to 0.92), negative symptoms (n = 523, 1 RCT, RR 0.82 95% CI 0.68 to 0.99),
somnolence (n = 523, 1 RCT, RR 0.80 95% CI 0.69 to 0.93) and
weight gain (n = 523, 1 RCT, RR 0.84 95% CI 0.76 to 0.94). Significantly more people given
aripiprazole reported symptoms of
nausea (n = 2881, 3 RCTs, RR 3.13 95% CI 2.12 to 4.61) but
weight gain (7% or more of total
body weight) was less common in people allocated
aripiprazole (n = 330, 1 RCT, RR 0.35 95% CI 0.19 to 0.64).
Aripiprazole may have value in aggression but data are limited. This will be the focus of another review.
AUTHORS' CONCLUSIONS: