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

Figures & data

Figure 1. Flowchart of the literature search and study selection.

Table 1. Baseline characteristics of the included studies.

Study	Treatment group	N of patients	Duration (w)	Age	Male (%)
[40]	Quetiapine 750 mg/d	96	6	36 ± 9	69.0
	placebo	96		38 ± 10	67.0
[30]	Quetiapine 750 mg/d	54	6	35 ± 10	70.4
	Quetiapine 600 mg/d	51		39 ± 8	74.5
	Quetiapine 300 mg/d	52		38 ± 9	71.2
	Placebo	51		36 ± 8	80.4
[38]	Ziprasidone 120 mg/d	47	4	38.8 (19–59)	83.0
	Placebo	48		39.0 (21–76)	85.0
[41]	Aripiprazole 10–30 mg/d	128	4	39.8	63.0
	Ziprasidone 80–160 mg/d	125		40.8	71.0
[33]	Ziprasidone 160 mg/d	149	4	40.0 ± 9.9	75.8
	Placebo	149		40.7 ± 10.4	76.5
[37]	Aripiprazole 12–30 mg/d	21	8	42.1 ± 12.4	38.0
	Quetiapine 300–750 mg/d	20		39.8 ± 11.2	20.0
[36]	Quetiapine 800 mg/d	74	6	15.45 ± 1.34	59.5
	Quetiapine 400 mg/d	73		15.45 ± 1.25	58.9
	Placebo	73		15.34 ± 1.39	57.5
[32]	Aripiprazole 3–30 mg/d	81	6	32.6 ± 11.1	48.7
	Quetiapine 100–600 mg/d	73		31.0 ± 9.2	66.1
[35]	Ziprasidone 40–160 mg/d	193	6		56.5
	Placebo	90			68.9
[39]	Aripiprazole lauroxil 882 mg/m	208	12	39.7 ± 11.1	68.8
	Aripiprazole lauroxil 441 mg/m	207		39.9 ± 10.1	68.1
	Placebo	207		39.5 ± 11.9	66.8
[34]	Aripiprazole 10 mg/d	150	6	39.3 ± 10.8	61.8
	Placebo	149		38.2 ± 11.3	63.4
[31]	Aripiprazole 15 mg	20	4	35 ± 10	90.0
	placebo	38		36 ± 12	71.0

Note: w; weekly; d: daily; m: monthly.

Table 2. Network meta-analysis for PANSS and BPRS.

Aripiprazole	−1.88 (−8.91, 3.97)	−4.06 (−10.22, 1.53)	−9.01 ( −15.81, −3.12)
−0.31 (−9.13, 8.63)	Quetiapine	−2.14 (−7.30, 3.33)	−7.13 (−9.78, −4.29)
−3.42 (−11.22, 4.51)	−3.18 (−12.95, 6.91)	Ziprasidone	−4.97 (−9.96, −0.21)
−6.98 (−12.35, −1.38)	−6.66 (−13.57, 0.23)	−3.54 (−10.53, 3.46)	Placebo
Treatment	PANSS (MD, 95%CrI)		BPRS (MD, 95%CrI)

Comparisons between drugs should be read from left to right. The estimates are located at the crossing between the column-defining treatment and row-defining treatment. For PANSS and BPRS, an MD lower than 0.00 favours the column-defining treatment. The significant results are presented in bold. PANSS, Positive and Negative Syndrome Scale; BPRS, Brief Psychiatric Rating Scale; MD, mean difference; CrI, credible interval.

Table 3. Network meta-analysis for acceptability and tolerability.

Aripiprazole	0.30 (−0.20, 0.72)	0.07 (−0.42, 0.52)	−0.25 (−0.68, 0.13)
1.11 (0.72, 1.74)	Quetiapine	−0.23 (−0.67, 0.28)	−0.55 ( −0.82, −0.25)
0.80 (0.55, 1.18)	0.72 (0.45, 1.17)	Ziprasidone	−0.32 (−0.73, 0.06)
0.54 (0.41, 0.73)	0.49 (0.36, 0.68)	0.68 (0.48, 0.96)	Placebo
Treatment	Acceptability (OR, 95%CrI)		CGI-S (MD, 95%CrI)

Comparisons between drugs should be read from left to right. The estimates are located at the crossing between the column-defining treatment and row-defining treatment. For acceptability, an OR lower than 1.00 favuors the column-defining treatment. For CGI-S, an MD lower than 0.00 favours the column-defining treatment. The significant results are presented in bold. Acceptability, the proportion of patients who discontinued the study early due to any reason; CGI-S, Clinical Global Impressions of severity scale; OR, odds ratio; MD, mean difference; CrI, credible interval.

Figure 2. The overall benefit-risk rank to be the best treatment in terms of PANSS, CGI-S, BPRS, acceptability. Rank 1 is the best; rank n is the worst.

Table 4. Summary for the benefit risk analysis.

	Outcome	Type	Placebo	PSA	Difference (95% CI)
Aripiprazole vs Placebo
Benefit	BPRS	Continuous	−3.50 (−8.90, 1.91)	−12.64 (−20.96, −4.32)	−9.14 (−15.47, −2.82)
Benefit	CGI severity	Continuous	−0.37 (−0.71, −0.03)	−0.63 (−1.15, −0.10)	−0.26 (−0.65, 0.14)
Benefit	PANSS	Continuous	−12.02 (−17.31, −6.74)	−18.95 (−26.45, −11.46)	−6.93 (−12.24, −1.62)
Risk	Acceptability	Rate	0.49 (0.41, 0.58)	0.35 (0.25, 0.45)	0.54 (0.41, 0.72)
Quetiapine vs Placebo
Benefit	BPRS	Continuous	−3.50 (−8.90, 1.91)	−10.60 (−16.65, −4.56)	−7.10 (−9.81, −4.40)
Benefit	CGI severity	Continuous	−0.37 (−0.71, −0.03)	−0.92 (−1.36, −0.48)	−0.55 (−0.83, −0.27)
Benefit	PANSS	Continuous	−12.02 (−17.31, −6.74)	−18.69 (−27.21, −10.18)	−6.67 (−13.34, 0.00)
Risk	Acceptability	Rate	0.49 (0.41, 0.58)	0.32 (0.23, 0.44)	0.49 (0.35, 0.69)
Ziprasidone vs Placebo
Benefit	BPRS	Continuous	−3.50 (−8.90, 1.91)	−8.53 (−15.75, −1.30)	−5.03 (−9.82, −0.23)
Benefit	CGI severity	Continuous	−0.37 (−0.71, −0.03)	−0.69 (−1.20, −0.18)	−0.32 (−0.70, 0.05)
Benefit	PANSS	Continuous	−12.02 (−17.31, −6.74)	−15.57 (−24.20, −6.95)	−3.55 (−10.36, 3.26)
Risk	Acceptability	Rate	0.49 (0.41, 0.58)	0.40 (0.29, 0.52)	0.68 (0.48, 0.95)

PSA: Prolactin Sparing Antipsychotics; PANSS, Positive and Negative Syndrome Scale; BPRS, Brief Psychiatric Rating Scale, CGI-S, Clinical Global Impressions of severity scale, Acceptability, the proportion of patients who discontinued the study early due to any reason. The significant results are presented in bold.

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