NPCi Blog: Aripiprazole versus conventional (typical) antipsychotics for schizophreni

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This Blog provides a quick and succinct commentary on a recent Cochrane review of the efficacy and safety of aripiprazole vs. conventional (typical) antipsychotics for schizophrenia.
The review had noted that aripiprazole and conventional antipsychotics had similar efficacy with regard to symptom improvement, but aripiprazole appeared to offer a favourable adverse-effect profile, with a lower risk of extra-pyramidal symptoms, hyperprolactinaemia, raised blood glucose and sinus tachycardia.

The blog notes the following:

• Most of the studies on which the review was based were short-term and data reporting was considered to be poor.
• Although aripiprazole is suggested to offer a possible advantage over conventional antipsychotics regarding compliance, the drop out rate of patients receiving aripiprazole in one long-term study reported was still very high at 57%.
• None of the studies in the review reported relapse, which is the outcome of most interest once an acute episode has been controlled.

The blog concludes “further longer-term data, especially those comparing aripiprazole with other atypical antipsychotics, are required before it can be recommended for routine use ahead of other more established less expensive atypical antipsychotics; however, aripiprazole may be an option to consider where they are ineffective or not tolerated.”. It adds that the NICE guideline on prescribing and monitoring of antipsychotics should continue to be followed and GPs should consider referring patients where adherence to treatment is poor, or they suffer unacceptable side effects.
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