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Long-Acting Injectable (LAI) Aripiprazole Formulations in the Treatment of Schizophrenia and Bipolar Disorder: a Systematic Review

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Abstract

Background

Several second-generation antipsychotics (SGAs) are available in long-acting injectable (LAI) formulations.

Objective

To systematically review the effects of the two formulations, Monohydrate and Lauroxil, of Aripiprazole LAI in patients with schizophrenia and bipolar disorder during an acute episode or during maintenance treatment.

Methods

On September 18, 2018, we adopted the following search strategy: (aripiprazole OR OPC-14597 OR Abilify) AND (long-acting OR depot OR LAI OR once monthly OR prolonged release OR monohydrate OR lauroxil) on PubMed, Cochrane, Scopus, CINAHL, PsycINFO, and Web of Science to identify randomised controlled trials. Furthermore, we searched the ClinicalTrials.gov site for possible additional studies.

Results

We included 28 papers dealing with randomised assignment of aripiprazole LAI formulations in schizophrenia and bipolar disorder in survival studies after stabilisation, in acute studies, and in head-to-head comparisons. Both monohydrate and lauroxil formulations reduced relapses/recurrences with respect to comparators (placebo or 50 mg once-monthly monohydrate) and improved symptomatology in acute schizophrenia.

Limitations

Only a small number of studies were included in our review, with widely overlapping samples. While a high proportion of studies were wholly or partly industry-sponsored, their outcomes do not appear to have been affected.

Conclusion

Aripiprazole LAI may to be efficacious in reducing relapse of schizophrenia and bipolar disorder in the long term in stabilised patients and in improving symptoms of schizophrenia during its acute phase, with both monohydrate and lauroxil formulations showing efficacy.

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Acknowledgements

We gratefully acknowledge the contribution of the Librarians of the School of Medicine and Psychology of Sapienza University, Ms. Mimma Ariano, Ms. Felicia Proietti, Ms. Ales Casciaro, Ms. Teresa Prioreschi, and Ms. Susanna Rospo for rendering precious bibliographical material accessible, as well as our Secretary Lucilla Martinelli for her assistance during the writing of this manuscript.

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Authors and Affiliations

  1. Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy

    Chiara Rapinesi, Georgios D. Kotzalidis, Lorenzo Mazzarini, Roberto Brugnoli, Stefano Ferracuti, Sergio De Filippis, Ilaria Cuomo, Gloria Giordano, Antonio Del Casale, Gloria Angeletti, Gabriele Sani & Paolo Girardi

  2. Sant’Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy

    Chiara Rapinesi, Georgios D. Kotzalidis, Lorenzo Mazzarini, Roberto Brugnoli, Stefano Ferracuti, Sergio De Filippis, Ilaria Cuomo, Gloria Giordano, Antonio Del Casale, Gloria Angeletti, Gabriele Sani & Paolo Girardi

  3. Salvator Mundi International Hospital-UPMC, Rome, Italy

    Lorenzo Mazzarini & Paolo Girardi

  4. Department of Human Neuroscience, Sapienza University, Rome, Italy

    Stefano Ferracuti

  5. Department of Neuropsychiatry, Villa von Siebenthal Neuropsychiatric Hospital and Clinic, Genzano di Roma, Rome, Italy

    Sergio De Filippis & Gloria Giordano

  6. Regina Cœli Penitentiary, RM1, Rome, Italy

    Ilaria Cuomo

  7. Lucio Bini Center, Aretæus Onlus, Rome, Italy

    Gabriele Sani & Paolo Girardi

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  1. Chiara Rapinesi
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Correspondence to Georgios D. Kotzalidis.

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Conflict of interest

Drs. Girardi and Brugnoli received research grants from Otsuka during 2016–2017; Dr. Girardi received educational and research funds from Janssen, Lilly, Angelini, and Springer. All other authors have no relevant affiliations or financial involvement with any organisation or entity with a financial interest in, or financial conflict with the subject matter or materials discussed in the manuscript.

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Rapinesi, C., Kotzalidis, G.D., Mazzarini, L. et al. Long-Acting Injectable (LAI) Aripiprazole Formulations in the Treatment of Schizophrenia and Bipolar Disorder: a Systematic Review. Clin Drug Investig 39, 713–735 (2019). https://doi.org/10.1007/s40261-019-00801-9

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