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

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%Cl:-75.05 to-25.81),p<0.00001;l2=99%),female patients(two RCTs,n=186;WMD:-22.58 ng/mL(95%Cl:-25.67 to-19.49),p<0.00001;l2=0%)and male patients(two RCTs,n=127;WMD:-68.80 ng/mL(95%Cl:-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;l2=96%).The aripiprazole group was s叩erior 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%Cl:-0.79 to-0.24),p=0.0002;l2=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.

对精神分裂症患者血脂异常的瑞舒伐他汀辅助治疗的疗效与安全性的的Meta分析（英文）

背景:精神分裂症患者的代谢综合征是一个重要的健康问题。瑞舒伐他汀对血脂异常的辅助性治疗的有效性和安全性存在争议。目的:评价瑞舒伐他汀对精神分裂症患者血脂异常的辅助性治疗的有效性和安全性。方法:我们从以下数据库中系统地检索了2017年9月28日以前相关的临床对照试验:Pub Med、Psyc INFO、Cochrane图书馆、中国知网、万方数据库、中国生物医学文献数据库。我们计算了标准平均差(SMD)、风险比(RR)及其95%的可信区间(CIs)。使用偏移评估工具中的Cochrane风险评估来评价所纳入研究的质量。并采用GRADE系统推荐的等级方法(推荐、评估、发展、评价的等级)作为参照标准。结果:确认和分析了4项比较瑞舒伐他汀组(n=138)和对照组(n=136)的研究(n=274)。瑞舒伐他汀辅助治疗显示对低密度脂蛋白胆固醇(LDL-C)[4项试验,n=272,SMD:-1.31(95%CI:-1.93,-0.70),I^2=81%]、总胆固醇(2项试验,n=164,SMD:-2.00(95%CI:-2.79,-1.21);I^2=76%)、和甘油三酯(2项试验,n=164,SMD:-1.05(95%CI:-1.38,-0.72);I^2=0%)的疗效比对照组更有效,但对高密度脂蛋白胆固醇(2项试验,n=164,SMD:0.14(95%CI:-0.16,0.45);I^2=0%)的疗效没有显著差异。去除一项没有随机试验的LDL-C研究之后,显著差异仍然存在[3项试验,n=172,SMD:-1.07(95%CI:-1.60,-0.53);I^2=63%]。体重(3项试验,n=208,SMD:-0.40(95%CI:-1.29,0.49);I^2=89%)、身体质量指数(2项试验,n=164,SMD:-0.34(95%CI:-1.23,0.56);I^2=87%)、腰围(3项试验,n=208,SMD:-0.43(95%CI:-1.31,0.46);I^2=89%)、空腹血糖(4项试验,n=272,SMD:-0.25(95%CI:-0.65,0.15);I^2=62%)方面组间没有显著的差异。两组之间的不良反应及停药率相近。根据GRADE分级方法,主要结果的证据水平低被评为"非常低"(35.3%)到"低"(64.7%)。其中,主要结果(LDL-C)被评为"非常低"。结论:对精神分裂症患者血脂异常的瑞舒伐他汀辅助性治疗的现有数据尚不足以对其有效性和安全性做出明确的解释。需进一步针对高质量的延长治疗时间的随机对照试验来验证该结论。