Efficacy and acceptability of three prolactin-sparing antipsychotics in patient with schizophrenia: a network meta-analysis

<b>Background:</b> The present study aimed to systematically evaluate three prolactin-sparing antipsychotics for treating schizophrenia. <b>Methods:</b> We performed a meta-analysis of three prolactin-sparing antipsychotics in patients with schizophrenia. Endpoints of interest were the Positive and Negative Syndrome Scale (PANSS), Brief Psychiatric Rating Scale (BPRS), Clinical Global Impressions-Severity (CGI-S) and acceptability (all cause discontinuation). <b>Results:</b> A total of 12 trials (2,723 patients) and three drugs (aripiprazole, quetiapine, and ziprasidone) were included. On the PANSS scale, aripiprazole (mean difference [MD]: −6.98, 95% CrI: −12.35, −1.38) was statistically more effective than placebo. When assessed by BPRS, aripiprazole (MD: −9.01, 95% CrI: −15.81, −3.12), quetiapine (MD: −7.13, 95% CrI: −9.78, −4.29) and ziprasidone (MD: −4.97, 95% CrI: 9.96, −0.21) had greater efficacy, when compared to placebo. Regarding CGI-S, quetiapine (MD: −0.55, 95% CrI: −0.82, −0.25) was significantly superior to placebo. In terms of acceptability, aripiprazole (OR: 0.54, 95% CrI: 0.41, 0.73), quetiapine (OR: 0.49, 95% CrI: 0.36, 0.68) and ziprasidone (OR: 0.68, 95% CrI: 0.48, 0.96) were more acceptable than placebo. The benefit risk analysis revealed that quetiapine has the best efficacy and acceptability profile among the three prolactin-sparing antipsychotics. <b>Conclusions:</b> Quetiapine may offer an optimal benefit-risk balance when a prolactin-sparing antipsychotic is indicated.

**背景：** 本研究旨在系统评价三种催乳素保留型抗精神病药物（prolactin-sparing antipsychotics）治疗精神分裂症的临床疗效。**方法：** 本研究针对精神分裂症患者开展了一项荟萃分析（meta-analysis），关注的主要结局指标包括阳性与阴性症状量表（Positive and Negative Syndrome Scale，PANSS）、简明精神病评定量表（Brief Psychiatric Rating Scale，BPRS）、临床总体印象-严重程度量表（Clinical Global Impressions-Severity，CGI-S）评分以及治疗可接受性（以任何原因停药作为评估指标）。**结果：** 本研究共纳入12项试验，涉及2723例患者与3种受试药物：阿立哌唑（aripiprazole）、喹硫平（quetiapine）与齐拉西酮（ziprasidone）。在阳性与阴性症状量表评分方面，阿立哌唑（均数差[MD]：-6.98，95%可信区间[CrI]：-12.35~-1.38）的临床疗效显著优于安慰剂。以简明精神病评定量表进行评估时，阿立哌唑（MD：-9.01，95% CrI：-15.81~-3.12）、喹硫平（MD：-7.13，95% CrI：-9.78~-4.29）与齐拉西酮（MD：-4.97，95% CrI：9.96~-0.21）的疗效均显著优于安慰剂。针对临床总体印象-严重程度量表评分，喹硫平（MD：-0.55，95% CrI：-0.82~-0.25）的疗效显著优于安慰剂。在治疗可接受性方面，阿立哌唑（比值比[OR]：0.54，95% CrI：0.41~0.73）、喹硫平（OR：0.49，95% CrI：0.36~0.68）与齐拉西酮（OR：0.68，95% CrI：0.48~0.96）的治疗可接受性均优于安慰剂。效益风险分析结果显示，在三种催乳素保留型抗精神病药物中，喹硫平的疗效与治疗可接受性综合表现最优。**结论：** 当临床需要选用催乳素保留型抗精神病药物时，喹硫平或许能提供最优的效益风险平衡。