Abstract
This network meta-analysis assessed the efficacy and tolerability of lurasidone versus other oral atypical antipsychotic monotherapies in adolescent schizophrenia. A systematic literature review identified 13 randomized controlled trials of antipsychotics in adolescents with schizophrenia-spectrum disorders. A Bayesian network meta-analysis compared lurasidone to aripiprazole, asenapine, clozapine, olanzapine, paliperidone extended-release (ER), quetiapine, risperidone, and ziprasidone. Outcomes included Positive and Negative Syndrome Scale (PANSS), Clinical Global Impressions-Severity (CGI-S), weight gain, all-cause discontinuation, extrapyramidal symptoms (EPS), and akathisia. Results were reported as median differences for continuous outcomes and odds ratios (ORs) for binary outcomes, along with 95% credible intervals (95% CrI). Lurasidone was significantly more efficacious than placebo on the PANSS (− 7.95, 95% CrI − 11.76 to − 4.16) and CGI-S (− 0.44, 95% CrI − 0.67 to − 0.22) scores. Lurasidone was associated with similar weight gain to placebo and statistically significantly less weight gain versus olanzapine (− 3.62 kg, 95% CrI − 4.84 kg to − 2.41 kg), quetiapine (− 2.13 kg, 95% CrI − 3.20 kg to − 1.08 kg), risperidone (− 1.16 kg, 95% CrI − 2.14 kg to − 0.17 kg), asenapine (− 0.98 kg, 95% CrI − 1.71 kg to − 0.24 kg), and paliperidone ER (− 0.85 kg, 95% CrI − 1.57 kg to − 0.14 kg). The odds of all-cause discontinuation were significantly lower for lurasidone than aripiprazole (OR = 0.28, 95% CrI 0.10–0.76) and paliperidone ER (OR = 0.25, 95% CrI 0.08–0.81) and comparable to other antipsychotics. Rates of EPS and akathisia were similar for lurasidone and other atypical antipsychotics. In this network meta-analysis of atypical antipsychotics in adolescent schizophrenia, lurasidone was associated with similar efficacy, less weight gain, and lower risk of all-cause discontinuation compared to other oral atypical antipsychotics.
Highlights
Schizophrenia is a severe, chronic, disabling mental illness associated with pronounced psychiatric symptoms, physical comorbidities, and increased mortality rates [1, 2]
Atypical antipsychotics are recommended over typical antipsychotics as first-line treatment for adolescent patients with schizophrenia [1] due to a reduced risk of extrapyramidal symptoms (EPS) and akathisia [1, 10]
These results suggest that lurasidone is an efficacious treatment for adolescent patients with schizophrenia with a lower risk of weight gain than most atypical antipsychotics
Summary
Schizophrenia is a severe, chronic, disabling mental illness associated with pronounced psychiatric symptoms, physical comorbidities, and increased mortality rates [1, 2]. Several lines of evidence suggest that patients with schizophrenia may accrue progressive chronicity and disability over time such that,. Atypical antipsychotics are recommended over typical antipsychotics as first-line treatment for adolescent patients with schizophrenia [1] due to a reduced risk of extrapyramidal symptoms (EPS) and akathisia [1, 10]. Adolescent patients appear susceptible to metabolic issues, including long-term risk of diabetes and hyperlipidemia [1]; treatment guidelines recommend ongoing weight and metabolic monitoring when using antipsychotics in this population [1, 10, 11]
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