Adjunctive Brexpiprazole as a Novel Effective Strategy for Treating Major Depressive Disorder: A Systematic Review and Meta-Analysis

Seoyoung Yoon, Sang Won Jeon, Young-Hoon Ko, Ashwin A. Patkar, Prakash S. Masand, Chi Un Pae, Changsu Han

Research output: Contribution to journalReview article

7 Citations (Scopus)

Abstract

Purpose/Background Brexpiprazole was approved for adjunctive treatment of major depressive disorder (MDD) in 2015. Because only a small number of randomized controlled trials have investigated the use of brexpiprazole in MDD, we performed a meta-analysis. Methods/Procedures We systematically searched literatures in PubMed, Cochrane Library database, EMBASE, Google Scholar, and clinicaltrials.gov up to January 2016. The primary efficacy measure was the mean change in total Montgomery-Åsberg Depression Rating Scale (MADRS) score from baseline. Secondary efficacy measures were the mean change in total Hamilton Rating Scale for Depression (17 items) score from baseline and the response (≥50% reduction in MADRS total score) and remission (MADRS total score ≤ 10 with ≥50% reduction) rates. Findings/Results Four studies fulfilled the inclusion criteria and were included in the analysis. Brexpiprazole showed superior efficacy over placebo with effect sizes (mean differences) of-1.76 (95% confidence interval [CI],-2.45 to-1.07) for MADRS and-1.21 (95% CI,-1.71 to-0.72) for the 17-item Hamilton Rating Scale for Depression. The risk ratios for response and remission were 1.57 (95% CI, 1.29-1.91) and 1.55 (95% CI, 1.22-1.96), respectively. The incidences of discontinuation due to adverse events, akathisia, and weight increase were higher in the brexpiprazole group than in the placebo group, with risk ratios of 3.44 (95% CI, 1.52-7.80), 3.39 (95% CI, 2.08-5.51), and 4.36 (95% CI, 2.45-7.77), respectively, and the incidence of akathisia was related to the brexpiprazole dose. Implications/Conclusions Although our results suggest that brexpiprazole could be an effective adjunctive agent for MDD, they should be cautiously translated into clinical practice because the meta-analysis was based on only a handful of randomized controlled trials.

Original languageEnglish
Pages (from-to)46-53
Number of pages8
JournalJournal of Clinical Psychopharmacology
Volume37
Issue number1
DOIs
Publication statusPublished - 2017 Feb 1

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Major Depressive Disorder
Meta-Analysis
Confidence Intervals
Psychomotor Agitation
Depression
Randomized Controlled Trials
Odds Ratio
Placebo Effect
Incidence
brexpiprazole
PubMed
Libraries
Placebos
Databases
Weights and Measures

Keywords

  • brexpiprazole
  • efficacy
  • major depressive disorder
  • meta-analysis
  • OPC-34712
  • tolerability

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Pharmacology (medical)

Cite this

Adjunctive Brexpiprazole as a Novel Effective Strategy for Treating Major Depressive Disorder : A Systematic Review and Meta-Analysis. / Yoon, Seoyoung; Jeon, Sang Won; Ko, Young-Hoon; Patkar, Ashwin A.; Masand, Prakash S.; Pae, Chi Un; Han, Changsu.

In: Journal of Clinical Psychopharmacology, Vol. 37, No. 1, 01.02.2017, p. 46-53.

Research output: Contribution to journalReview article

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abstract = "Purpose/Background Brexpiprazole was approved for adjunctive treatment of major depressive disorder (MDD) in 2015. Because only a small number of randomized controlled trials have investigated the use of brexpiprazole in MDD, we performed a meta-analysis. Methods/Procedures We systematically searched literatures in PubMed, Cochrane Library database, EMBASE, Google Scholar, and clinicaltrials.gov up to January 2016. The primary efficacy measure was the mean change in total Montgomery-{\AA}sberg Depression Rating Scale (MADRS) score from baseline. Secondary efficacy measures were the mean change in total Hamilton Rating Scale for Depression (17 items) score from baseline and the response (≥50{\%} reduction in MADRS total score) and remission (MADRS total score ≤ 10 with ≥50{\%} reduction) rates. Findings/Results Four studies fulfilled the inclusion criteria and were included in the analysis. Brexpiprazole showed superior efficacy over placebo with effect sizes (mean differences) of-1.76 (95{\%} confidence interval [CI],-2.45 to-1.07) for MADRS and-1.21 (95{\%} CI,-1.71 to-0.72) for the 17-item Hamilton Rating Scale for Depression. The risk ratios for response and remission were 1.57 (95{\%} CI, 1.29-1.91) and 1.55 (95{\%} CI, 1.22-1.96), respectively. The incidences of discontinuation due to adverse events, akathisia, and weight increase were higher in the brexpiprazole group than in the placebo group, with risk ratios of 3.44 (95{\%} CI, 1.52-7.80), 3.39 (95{\%} CI, 2.08-5.51), and 4.36 (95{\%} CI, 2.45-7.77), respectively, and the incidence of akathisia was related to the brexpiprazole dose. Implications/Conclusions Although our results suggest that brexpiprazole could be an effective adjunctive agent for MDD, they should be cautiously translated into clinical practice because the meta-analysis was based on only a handful of randomized controlled trials.",
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AU - Patkar, Ashwin A.

AU - Masand, Prakash S.

AU - Pae, Chi Un

AU - Han, Changsu

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N2 - Purpose/Background Brexpiprazole was approved for adjunctive treatment of major depressive disorder (MDD) in 2015. Because only a small number of randomized controlled trials have investigated the use of brexpiprazole in MDD, we performed a meta-analysis. Methods/Procedures We systematically searched literatures in PubMed, Cochrane Library database, EMBASE, Google Scholar, and clinicaltrials.gov up to January 2016. The primary efficacy measure was the mean change in total Montgomery-Åsberg Depression Rating Scale (MADRS) score from baseline. Secondary efficacy measures were the mean change in total Hamilton Rating Scale for Depression (17 items) score from baseline and the response (≥50% reduction in MADRS total score) and remission (MADRS total score ≤ 10 with ≥50% reduction) rates. Findings/Results Four studies fulfilled the inclusion criteria and were included in the analysis. Brexpiprazole showed superior efficacy over placebo with effect sizes (mean differences) of-1.76 (95% confidence interval [CI],-2.45 to-1.07) for MADRS and-1.21 (95% CI,-1.71 to-0.72) for the 17-item Hamilton Rating Scale for Depression. The risk ratios for response and remission were 1.57 (95% CI, 1.29-1.91) and 1.55 (95% CI, 1.22-1.96), respectively. The incidences of discontinuation due to adverse events, akathisia, and weight increase were higher in the brexpiprazole group than in the placebo group, with risk ratios of 3.44 (95% CI, 1.52-7.80), 3.39 (95% CI, 2.08-5.51), and 4.36 (95% CI, 2.45-7.77), respectively, and the incidence of akathisia was related to the brexpiprazole dose. Implications/Conclusions Although our results suggest that brexpiprazole could be an effective adjunctive agent for MDD, they should be cautiously translated into clinical practice because the meta-analysis was based on only a handful of randomized controlled trials.

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