Asenapine for aggressive behaviours in psychiatric disorders: a systematic review of efficacy and real-world effectiveness

Clinical decision-making for the pharmacological treatment of aggressive behaviour in psychiatry remains challenging. Asenapine, a second-generation antipsychotic with a higher affinity for dopamine D4 than for D2 receptors, may become a treatment option, although this remains to be demonstrated. A systematic search was conducted across biomedical databases according to PRISMA Reporting Items for Systematic Review. We aimed to examine the efficacy and effectiveness of asenapine in the management of aggressive behaviours including psychomotor agitation, hostility, irritability, anger, impulsivity, self-harm, behavioural disinhibition, as well as physical and verbal aggression, across psychiatric disorders. Of the 12 studies included, four reported asenapine’s efficacy in aggressive behaviours compared to placebo, and five described the effectiveness in uncontrolled settings. Three studies found no advantages over olanzapine. Major evidence supports asenapine’s efficacy in reducing psychomotor agitation and hostility, with benefits independent of its anti-manic and antipsychotic effects. Asenapine may be a viable option for the treatment of psychomotor agitation and hostility, although more head-to-head trials are needed to clarify its efficacy relative to other antipsychotics. Since the evidence of efficacy in other aggressive domains and diagnoses is still limited, clinicians should primarily consider the tolerability profile to guide their prescription.精神科攻击行为药物治疗的临床决策仍颇具挑战。阿塞那平（Asenapine）作为第二代抗精神病药，对多巴胺D4受体的亲和力高于D2受体，或可成为潜在治疗选择，但其有效性尚待证实。本研究依据系统综述优先报告条目（PRISMA Reporting Items），在多座生物医学数据库中开展了系统性检索，旨在评估阿塞那平在各类精神障碍患者中，针对包括精神运动性激越、敌意、易激惹、愤怒、冲动、自伤、行为脱抑制以及躯体和言语攻击在内的各类攻击行为的疗效与实际应用效果。纳入的12项研究中，4项报告了阿塞那平相较于安慰剂治疗攻击行为的疗效，5项描述了其在非对照研究环境中的实际应用效果；另有3项研究显示其疗效并不优于奥氮平。现有主要证据表明，阿塞那平可有效减轻精神运动性激越与敌意，且其获益独立于抗躁狂及抗精神病作用。阿塞那平或可作为精神运动性激越与敌意的可行治疗选择，但仍需开展更多头对头试验，以明确其相较于其他抗精神病药的疗效优劣。由于针对其他攻击行为类别及诊断人群的疗效证据仍较为有限，临床医师应主要参考其耐受性特征来指导处方决策。