The efficacy and tolerability of paliperidone in mania of bipolar disorder: A preliminary meta-analysis.

Paliperidone may be effective for the treatment of bipolar disorder (BD); however, the evidence has been mixed. This is the first meta-analysis to evaluate the efficacy, safety, and tolerability of paliperidone for the treatment of BD. We performed a systematic search of the literature using major electronic databases from inception to January 27, 2017. Randomized control trials (RCTs) investigating paliperidone treatment among patients with BD versus a placebo or other second-generation antipsychotics were included. We then performed exploratory random-effects meta-analysis. The 3 included RCTs compared paliperidone with placebo (667 patients received paliperidone and 369 received a placebo). The dose of paliperidone in the included studies ranged from 3 to 12 mg/day. Paliperidone did not significantly improve manic symptoms (Hedges' g = -0.221, p = .067, k = 5) compared with a placebo; however, it was superior to a placebo in improving psychosocial function (Hedges' g = -0.156, p = .042, k = 3) and general severity (Hedges' g = -0.205, p = .001, k = 5). Paliperidone was associated with a greater use of anticholinergic medications (p = .002), increased body weight (p < .001), and higher serum prolactin level (p < .001) compared with a placebo. Our preliminary results suggest that paliperidone does not offer significant benefits for the treatment of mania symptoms in BD compared with a placebo. In addition, treatment with paliperidone was associated with a higher incidence of adverse effects. Because of the limited number of studies, further well-designed RCTs are warranted. (PsycINFO Database Record

Efficacy, safety and tolerability of aripiprazole in bipolar disorder: An updated systematic review and meta-analysis of randomized controlled trials.

Numerous studies have investigated aripiprazole as a treatment for bipolar disorder (BD). therefore we conducted this comprehensive meta-analysis to investigate the efficacy and safety profile of aripiprazole in treating BD. Two authors conducted systematic searches of PubMed and ScienceDirect from inception until May 14th, 2017. Randomized controlled trials (RCTs) of people with BD who received aripiprazole were included. A total of 20 RCTs met the eligibility criteria, including two which investigated the efficacy of aripiprazole versus haloperidol (aripiprazole=340; haloperidol=337), three which compared aripiprazole versus lithium (aripiprazole=208; lithium=212), and 15 with multiple comparisons of aripiprazole versus a placebo (aripiprazole=1923; placebo=1499). Compared to a placebo, aripiprazole improved acute mania (Hedges' g: -0.299, p=0.001) and psychosis (Hedges' g: -0.296, p<0.001) in the acute mania state, but did not improve depressive symptoms (Hedges' g: -0.127, p=0.054) in the acute depressive state. Aripiprazole was associated with lower relapse rates in bipolar mania when used in combination versus a placebo in maintenance therapy (odds ratio: 0.522, p<0.029). Aripiprazole was also associated with higher levels of high density lipoprotein, lower dropout rates, but no difference in extrapyramidal symptoms in the maintenance phase versus a placebo or in comparison with other medications (haloperidol or lithium). Our results suggest that aripiprazole is effective and safe in treating bipolar mania. Further trials are necessary to evaluate the efficacy and tolerability versus other medications.