A randomized trial of aripiprazole vs blonanserin for the treatment of acute schizophrenia and related disorders

Abstract

ObjectiveThere has been no direct comparison of aripiprazole and blonanserin for schizophrenia treatment. We conducted a 24-week, rater-masked, randomized trial of aripiprazole (6−30 mg/d) vs blonanserin (4−24 mg/d) in schizophrenia patients who were not taking any antipsychotic medication for more than 2 weeks before enrollment (UMIN000011194).MethodsThe primary outcome measure for efficacy was improvement of Positive and Negative Syndrome Scale (PANSS) total score at week 24. Secondary outcomes were PANSS subscale scores, 21-item Hamilton Rating Scale for Depression (HAMD-21) score, response rate, discontinuation rate, and individual adverse events.ResultsForty-four patients were recruited. The discontinuation rate was 86.4% in the aripiprazole group and 68.2% in the blonanserin treatment group. There was no significant difference in mean time to discontinuation between the groups. Although both treatment groups showed significant reductions in the PANSS total score, PANSS subscale scores, and HAMD-21 scores at week 24, the magnitudes of the changes did not differ between the groups. There were no significant differences in the incidences of adverse events including somnolence, extrapyramidal symptoms, prolactin-related adverse events, and weight change between the groups.ConclusionOur results suggest similar efficacy and safety profiles of aripiprazole and blonanserin in the patients with schizophrenia. Double-blind controlled studies are needed to further explore the efficacy and safety of aripiprazole and blonanserin in schizophrenia.

Long‐term effectiveness of oral second‐generation antipsychotics in patients with schizophrenia and related disorders: a systematic review and meta‐analysis of direct head‐to‐head comparisons

“…Altogether, we included 63 reports (59 randomized studies) with 45,787 participants (median: 255 participants/study, range: from 12 to 18,154) (Table ). The mean age of the population was 37.6±7.0 years; 62.1±13.3% were male and 61.1±28.8% were white.…”

Efficacy, Tolerability, and Safety of Blonanserin in Schizophrenia: An Updated and Extended Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Therefore, we did not include data from these RCTs in the current meta-analysis. Altogether, we included 10 RCTs with 1521 participants (mean patient age = 37.8 ± 4.1 years; mean duration of study = 11.4 ± 6.5 weeks; range: 6-24 weeks; ▶ [2]. Sample sizes ranged from 18 to 307 participants.…”

“…Blonanserin is a well-known second-generation antipsychotic (SGA). It has setoronin 2A receptor (Ki = 0.812 nM), dopamine D 2 receptor (Ki = 0.142 nM), and dopamine D 3 receptor-blocking activity (Ki = 0.494 nM) as well as weak dopamine D 1 receptor-blocking activity (Ki = 1070 nM) and adrenergic alpha 1 receptor-blocking activity (Ki = 26.7 nM), but it is almost completely devoid of histamine H 1 (Ki > 100 nM) and muscarinic M 1 antagonist activity (Ki > 100 nM) [2][3][4]. Blonanserin has a unique pharmacological receptor profile, with higher dopamine D 2 receptor occupancy and lower serotonin 2A receptor-blocking activity compared with other SGAs [2,3].…”

“…Although dizziness and akathisia occur significantly less often with blonanserin than with haloperidol, blonanserin has a higher risk of akathisia than does risperidone [3]. Moreover, similar to aripiprazole, blonanserin produces less weight gain [2,[5][6][7]. Recently, 6 new randomized controlled trials (RCTs) have compared blonanserin with other antipsychotics [1,2,[8][9][10][11].…”

“…Moreover, similar to aripiprazole, blonanserin produces less weight gain [2,[5][6][7]. Recently, 6 new randomized controlled trials (RCTs) have compared blonanserin with other antipsychotics [1,2,[8][9][10][11]. To acquire more robust evidence with respect to the efficacy and safety of blonanserin for the treatment of schizophrenia, an updated systematic review and meta-analysis of all RCTs must be conducted.…”