| Objective Try to through searching literature in the openly published journals both in China and abroad about the efficacy and safety of Aripiprazole and Olanzapine for the schizophrenia, which were randomized controlled trials or clinical control study. On the basis of strict evaluation of literature to compare the efficacy and safety of Aripiprazole and Olanzapine for the schizophrenia and assess the differences on efficacy and safety between the two drugs in the clinic by using Meta-analysis, which could provide high quality evidence-based medical evidence for schizophrenia clinical application.Methods A thorough literature search was performed among Pubmed, Cochrane Library,CBMdisc, CNKI, Wanfang and VIP database through the Internet, aiming at the efficacy and safety of Aripiprazole and Olanzapine for the schizophrenia by randomized controlled trial(RCT) or clinical controlled trial(CCT) from 2005 to2015 in the openly published journals both in China and abroad. All the literature were further selected by rigid criteria formed in advance to include or exclude samples. The included literature was evaluated by Jadad Quality Scale and the data was extracted by self-designed data-extracting tables. All the data extracted was put in Rev Man 5.3 software, which was used for analyzing, heterogeneity test and mapping forest figure and funnel; The binary variable was analyzed by OR, while the continuous variable was analyzed by MD, the research heterogeneity was judged by the results of heterogeneity test-P value, which manifested in the forest plots. Using the funnel plots produced by Stata12.0 Begg ’s method to analyze the publication bias.ResultsResults(1)According to the inclusion and exclusion criteria, 49 papers were finally included, 48 of which in Chinese and 1 in English. Only 2 papers were high qualityresearch scored from 3 to 5, while 47 papers were low quality scored from 0 to 2 by Jadad Quality Scale; 48 papers were RCT and only 1 paper was CCT.(2)It is manifested that from the combined analysis of the therapeutic effect,total effective rate, effective rate, cure rate all have the homogeneity(P>0.05) and have no significant difference between Aripiprazole and Olanzapine groups(Z=0.80,P=0.43;Z=0.53,P=0.60;Z=0.57,P=0.57), the pooled-OR(95%CI)showed 0.92(0.76,1.12)、0.95(0.79,1.15)' 0.95(0.79,1.14). The scores in PANSS,positive symptoms, negative symptoms and general pathologic symptoms had no significant difference between Aripiprazole and Olanzapine groups(Z=1.10,P=0.27;Z=0.37,P=0.71;Z=1.12,P=0.26;Z=0.02,P=0.99), the pooled-MD(95%CI)showed 0.96(-0.75,2.67)、0.20(-0.83,1.22)、0.58(-0.43,1.58)' 0.01(-1.51, 1.54). The publication bias analysis shown that the effective rate was asymmetry in forest plots(Z=2.11,P=0.035), suggesting the publication bias, while other index shown no publication bias. The results of sensitivity analysis shown that all the results were stable and had no significant difference except scores in PANSS,positive symptoms, negative symptoms and general pathologic symptoms.(3)The side effect analysis shown that lethargy in behavioral toxicity, it in Aripiprazole was lower than it in olanzapine group, pooled-OR(95%CI)shown a difference between the two groups [0.27(0.17,0.43)], while insomnia in Aripiprazole was higher than in Olanzapine group, pooled-OR shown a difference between the two groups[2.38(1.01,5.61)]. The side effect in plant nerve system toxicity like thirst in Aripiprazole was lower than it in Olanzapine group, pooled-OR shown a difference between the two groups[0.42(0.23,0.76)]. The incidence rate of abnormal liver function and body weight change(increase) in Aripiprazole was lower than Olanzapine group, pooled-OR shown a difference between the two groups[0.35(0.17,0.73); 0.12(0.07,0.19)]; Plant nerve system toxicity of constipation, blurred vision, cardiovascular system toxicity shown no statistically significant difference between the two groups.(4)In the self-control analysis, i.e., comparison of data before and after the treatment in Aripiprazole group showed that the CHOL and TG analysis by the pooled-MD(95%CI) shown no significant difference [-0.03(-0.08, 0.03);-0.04(-0.10,0.02)], while the FPG shown that the Aripiprazole could increase FPG level after treatment. The results documented that Olanzapine could cause the CHOL,TG and FPG level-up, and the pooled-MD(95%CI) had a significant difference[-0.63(-0.83,-0.44);-0.55(-0.72,-0.38);-0.62(-0.82,-0.42)]. For the CHOL analysis between the two treatment groups, the pooled-MD(95%CI) had a significant difference[-0.55(-0.80,-0.29)], for the TG-pooled analysis between the two treatment groups, the pooled-MD(95%CI) had a significant difference [-0.48(-0.68,-0.28)] and for the FPG-pooled analysis between the two treatment groups, the pooled-MD(95%CI) had a significant difference [-0.51(-0.70,-0.32)], all excluded 0,there were significant differences between the two groups, the levels of Aripiprazole were all lower than Olanzapine group.Conclusion By Meta-analysis, it can be easily seen that Aripiprazole had no difference from Olanzapine on efficacy for schizophrenia among 4-12 weeks. In the safety analysis of Aripiprazole and Olanzapine for the schizohrenia, the incidence of sleepiness, dry mouth, abnormal liver function and weight gain in Aripiprazole group is lower than in olanzapine, but the incidence of insomnia is higher. Both of the drugs can cause the patients’ blood glucose go up, but olanzapine affects more than Aripiprazole,Olanzapine also could increase CHOL and TG levels of patients; Since the including criteria is in a low quality, and there could be publication bias existing in some results,the findings are still need to be confirmed by high-quality RCT. |
PDF Full Text Request