Academic journal article General Psychiatry

Using Aripiprazole to Reduce Antipsychotic-Induced Hyperprolactinemia: Meta-Analysis of Currently Available Randomized Controlled Trials

Academic journal article General Psychiatry

Using Aripiprazole to Reduce Antipsychotic-Induced Hyperprolactinemia: Meta-Analysis of Currently Available Randomized Controlled Trials

Article excerpt

1. Background

Hyperprolactinemia (HPL) is a common and severe side effect of using antipsychotic medications. [1] Both typical antipsychotic medications (e.g., chlorpromazine, perphenazine, sulpiride, and haloperidol) and atypical antipsychotic medications (e.g., risperidone, paliperidone, and amisulpride) can increase prolactin levels, especially among females. The reported occurrence of HPL among individuals taking antipsychotic medication ranges from 42 to 89%. [2-5] HPL is associated with both short-term and long-term physical and psychological problems, including sexual dysfunction, amenorrhea, osteoporosis, the metabolic syndrome, depression, and anxiety. [2,6,7] There have also been reports that HPL can increase the risk of breast cancer and prostate cancer [8,9] and exacerbate auto-immune diseases. [10] Problems related to HPL can decrease patient adherence to treatment with antipsychotic medications and, thus, lead to fluctuations of psychotic symptoms. [11]

Aripiprazole is a partial dopamine D2 receptor agonist which has been reported to improve antipsychotics-induced HPL. [12-17] Several clinical trials specifically focused on assessing the efficacy and safety of aripiprazole in treating antipsychotic-induced HPL1 [18-23] have had inconsistent findings. Some found that adjunctive treatment with aripiprazole was well tolerated and effective in reducing prolactin levels, [20,24] while others reported increased insomnia, headaches, and sedation after the use of adjunctive aripiprazole. [18] Two studies [25,26] reported that aripiprazole was effective at low doses, but another study did not support this finding. [27] The single available meta-analysis on this topic [28] reported the aripiprazole is effective and safe, but these results were based on pooling results from only five studies. This review aims to identify and pool results of all previous randomized controlled trials to summarize the current state of knowledge about the efficacy and safety of aripiprazole in the treatment of antipsychotic-induced HPL.

2. Methods

2.1 Search strategy

We searched the following databases for studies published by January 20, 2015: Pubmed, EMBASE, The Cochrane Library, EBSCO, Chinese National Knowledge Infrastructure (CNKI), Chongqing VIP database for Chinese Technical Periodicals, WANFANG DATA, Chinese Biological Medical Literature Database, Taiwan Electronic Periodical Services, and ClinicalTrials.gov using keywords 'aripiprazole', 'hyperprolactinemia', 'prolactin abnormal', 'randomized controlled trial', 'controlled clinical trial', 'randomized, placebo', 'drug therapy', and 'randomly, trial'. Proprietary names for aripiprazole in Chinese were also included as the Chinese search terms. Various Boolean combinations of these keywords were used to search for articles; reference lists of included articles were hand-checked for further relevant studies; and experts in the field were asked about ongoing studies.

2.2 Inclusion and exclusion criteria

All reports of randomized controlled trails (RCTs) about treating antipsychotic-induced HPL among individuals with schizophrenia with aripiprazole were screened using the following inclusion criteria: (a) diagnosis of schizophrenia was based on criteria specified by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, [29] the World Health Organization's International Classification of Diseases, [30] or the Chinese Society of Psychiatry's Chinese Classification of Mental Disorders; [31] (b) HPL confirmed using blood tests; (c) comparison of aripiprazole to placebo or to no treatment; (d) reported data on sample size, number of HPL cases, and on serum prolactin levels before and after treatment. Studies published in either English or Chinese were considered. Observational studies, anthropologic studies, review articles, research protocols, case reports, and duplicated reports were excluded. …

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