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Abstract：
BACKGROUND: Behavioural and psychological symptoms of dementia (BPSD) are highly prevalent in people living with dementia. Second-generation antipsychotics (SGAs) are commonly used to treat BPSD, but their comparative efficacy and acceptability are unknown.
METHODS: The standard mean difference (SMD) was used to pool the fixed effects of continuous outcomes. We calculated ORs with corresponding 95% credible intervals (CI) for the categorical variable. Efficacy was defined as the scores improved on the standardised scales. Acceptability was defined as the all-cause dropout rate. Tolerability was defined as the discontinuation rate due to adverse effects (AEs). The relative treatment rankings were reported with the surface under the cumulative curve. The AE outcomes included mortality, cerebrovascular adverse events (CVAEs), falls, sedation, extrapyramidal symptoms and urinary symptoms.
RESULTS: Twenty randomised controlled trials with a total of 6374 individuals containing 5 types of SGAs (quetiapine, olanzapine, risperidone, brexpiprazole and aripiprazole) with intervention lengths ranging from 6 weeks to 36 weeks were included in this network meta-analysis. For the efficacy outcome, compared with the placebo, brexpiprazole (SMD=-1.77, 95% CI -2.80 to -0.74) was more efficacious, and brexpiprazole was better than quetiapine, olanzapine and aripiprazole. Regarding acceptability, only aripiprazole (OR=0.72, 95% CI 0.54 to 0.96) was better than the placebo, and aripiprazole was also better than brexpiprazole (OR=0.61, 95% CI 0.37 to 0.99). In terms of tolerability, olanzapine was worse than placebo (OR=6.02, 95% CI 2.87 to 12.66), risperidone (OR=3.67, 95% CI 1.66 to 8.11) and quetiapine (OR=3.71, 95% CI 1.46 to 9.42), while aripiprazole was better than olanzapine (OR=0.25, 95% CI 0.08 to 0.78). Quetiapine presented good safety in CVAE. Brexpiprazole has better safety in terms of falls and showed related safety in sedation among included SGAs.
CONCLUSIONS: Brexpiprazole showing great efficacy in the treatment of BPSD, with aripiprazole showing the highest acceptability and olanzapine showing the worst tolerability. The results of this study may be used to guide decision-making.
METHODS: The standard mean difference (SMD) was used to pool the fixed effects of continuous outcomes. We calculated ORs with corresponding 95% credible intervals (CI) for the categorical variable. Efficacy was defined as the scores improved on the standardised scales. Acceptability was defined as the all-cause dropout rate. Tolerability was defined as the discontinuation rate due to adverse effects (AEs). The relative treatment rankings were reported with the surface under the cumulative curve. The AE outcomes included mortality, cerebrovascular adverse events (CVAEs), falls, sedation, extrapyramidal symptoms and urinary symptoms.
RESULTS: Twenty randomised controlled trials with a total of 6374 individuals containing 5 types of SGAs (quetiapine, olanzapine, risperidone, brexpiprazole and aripiprazole) with intervention lengths ranging from 6 weeks to 36 weeks were included in this network meta-analysis. For the efficacy outcome, compared with the placebo, brexpiprazole (SMD=-1.77, 95% CI -2.80 to -0.74) was more efficacious, and brexpiprazole was better than quetiapine, olanzapine and aripiprazole. Regarding acceptability, only aripiprazole (OR=0.72, 95% CI 0.54 to 0.96) was better than the placebo, and aripiprazole was also better than brexpiprazole (OR=0.61, 95% CI 0.37 to 0.99). In terms of tolerability, olanzapine was worse than placebo (OR=6.02, 95% CI 2.87 to 12.66), risperidone (OR=3.67, 95% CI 1.66 to 8.11) and quetiapine (OR=3.71, 95% CI 1.46 to 9.42), while aripiprazole was better than olanzapine (OR=0.25, 95% CI 0.08 to 0.78). Quetiapine presented good safety in CVAE. Brexpiprazole has better safety in terms of falls and showed related safety in sedation among included SGAs.
CONCLUSIONS: Brexpiprazole showing great efficacy in the treatment of BPSD, with aripiprazole showing the highest acceptability and olanzapine showing the worst tolerability. The results of this study may be used to guide decision-making.
摘要：
背景：痴呆的行为和心理症状（BPSD）在痴呆症患者中非常普遍。第二代抗精神病药（SGAs）通常用于治疗BPSD，但它们的比较功效和可接受性尚不清楚。
方法：使用标准平均差（SMD）来汇集连续结局的固定效应。我们为分类变量计算了具有相应95%可信区间(CI)的OR。功效定义为在标准化量表上改善的分数。可接受性定义为全因脱落率。耐受性定义为由于不良反应(AE)导致的停药率。用累积曲线下的表面报告相对处理等级。AE结果包括死亡率，脑血管不良事件（CVAE），falls,镇静,锥体外系症状和泌尿症状。
结果：20项随机对照试验，共6374例，包含5种类型的SGA（喹硫平，奥氮平,利培酮,该网络荟萃分析包括了干预时间为6周至36周的宝立哌唑和阿立哌唑）。对于疗效结果，与安慰剂相比，巴立哌唑（SMD=-1.77，95%CI-2.80至-0.74）更有效，而布立哌唑优于喹硫平,奥氮平和阿立哌唑.关于可接受性，只有阿立哌唑（OR=0.72，95％CI0.54至0.96）优于安慰剂，阿立哌唑的疗效也优于巴立哌唑(OR=0.61,95%CI0.37~0.99)。在耐受性方面,奥氮平比安慰剂更差（OR=6.02，95％CI2.87至12.66），利培酮(OR=3.67,95%CI1.66~8.11)和喹硫平(OR=3.71,95%CI1.46~9.42),阿立哌唑优于奥氮平（OR=0.25，95％CI0.08至0.78）。喹硫平治疗CVAE具有良好的安全性。Brexpiprazole在跌倒方面具有更好的安全性，并且在包括的SGA中显示出相关的镇静安全性。
结论：Brexiprazole在治疗BPSD中显示出很好的疗效，阿立哌唑的可接受性最高，奥氮平的耐受性最差。这项研究的结果可用于指导决策。
方法：使用标准平均差（SMD）来汇集连续结局的固定效应。我们为分类变量计算了具有相应95%可信区间(CI)的OR。功效定义为在标准化量表上改善的分数。可接受性定义为全因脱落率。耐受性定义为由于不良反应(AE)导致的停药率。用累积曲线下的表面报告相对处理等级。AE结果包括死亡率，脑血管不良事件（CVAE），falls,镇静,锥体外系症状和泌尿症状。
结果：20项随机对照试验，共6374例，包含5种类型的SGA（喹硫平，奥氮平,利培酮,该网络荟萃分析包括了干预时间为6周至36周的宝立哌唑和阿立哌唑）。对于疗效结果，与安慰剂相比，巴立哌唑（SMD=-1.77，95%CI-2.80至-0.74）更有效，而布立哌唑优于喹硫平,奥氮平和阿立哌唑.关于可接受性，只有阿立哌唑（OR=0.72，95％CI0.54至0.96）优于安慰剂，阿立哌唑的疗效也优于巴立哌唑(OR=0.61,95%CI0.37~0.99)。在耐受性方面,奥氮平比安慰剂更差（OR=6.02，95％CI2.87至12.66），利培酮(OR=3.67,95%CI1.66~8.11)和喹硫平(OR=3.71,95%CI1.46~9.42),阿立哌唑优于奥氮平（OR=0.25，95％CI0.08至0.78）。喹硫平治疗CVAE具有良好的安全性。Brexpiprazole在跌倒方面具有更好的安全性，并且在包括的SGA中显示出相关的镇静安全性。
结论：Brexiprazole在治疗BPSD中显示出很好的疗效，阿立哌唑的可接受性最高，奥氮平的耐受性最差。这项研究的结果可用于指导决策。
