Objectives: Second generation antipsychotics (SGA) are associated with increased risk of metabolic side effects. A systematic literature review and mixed treatment comparisons (MTC) were performed to assess the efficacy and the metabolic side effects of antipsychotics, and more especially to compare lurasidone to other widely used antipsychotics in patient with acute schizophrenia. Methods: This review included short-term (= 12 weeks) randomised controlled trials (RCTs) in patients with an acute phase of schizophrenia. The literature search was based on the NICE guidelines on treatment for schizophrenia published in 2010. A systematic search in the most comprehensive medical databases of peer-reviewed articles (MEDLINE, EMBASE, CENTRAL) was conducted until June 2012 to update the evidence. In addition to lurasidone, eight comparators were considered: Amisulpride aripiprazole, haloperidol, olanzapine, quetiapine, risperidone, ziprasidone and placebo. A Bayesian ramdom effect MTC was performed on efficacy outcomes (PANSS total score and CGI-S score) and metabolic side effects (weight, triglycerides, total cholesterol level and fasting glucose level). Results: Thirty-nine RCTs involving 12,721 patients were included. Results showed that lurasidone had similar efficacy to others antipsychotics in terms of PANSS total score and CGI-S score and a similar effect as compared to placebo on all metabolic outcomes. The probability to have a lower impact than aripiprazole on weight increase and fasting glucose level was respectively 75.5% and 65.9%. Probabilities to have a lower impact on cholesterol level and triglycerides compared to olanzapine, quetiapine or riperidone varied from 98% to 100%. Conclusions: Efficacy has been demonstrated for all reviewed treatments vs. placebo, with a similar effect. Lurasidone had a similar effect as compared to placebo and a less negative impact than olanzapine, quetiapine and risperidone on weight increase, triglycerides, total cholesterol level and than olanzapine on fasting glucose level.
Guelfucci, F., Watt, M., Vimont, A., Roïz, J., & Cadi-Soussi, N. (2013). Comparative Efficacy and Metabolic Side Effects of Lurasidone for the Management of Acute Schizophrenia: A Systematic Literature Review and Mixed Treatment Comparison with First and Second Generation Antipsychotics. Value in Health, 16(7), A542–A543. https://doi.org/10.1016/j.jval.2013.08.1378