TY - JOUR
T1 - Pharmacological treatment strategies for lowering prolactin in people with a psychotic disorder and hyperprolactinaemia
T2 - A systematic review and meta-analysis
AU - Labad, Javier
AU - Montalvo, Itziar
AU - González-Rodríguez, Alexandre
AU - García-Rizo, Clemente
AU - Crespo-Facorro, Benedicto
AU - Monreal, José Antonio
AU - Palao, Diego
N1 - Funding Information:
Javier Labad and Itziar Montalvo have received an Intensification of the Research Activity Grant by the Health Department from the Generalitat de Catalunya (SLT006/17/00012 and SLT008/18/00074). Javier Labad has received an Intensification of the Research Activity Grant by the Instituto de Salud Carlos III (INT19/00071).
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Different therapeutic strategies are used for lowering prolactin concentrations in patients with psychotic disorders with antipsychotic-induced hyperprolactinaemia. We aimed to examine the evidence from open-label studies and randomized clinical trials (RCTs) that studied four prolactin-lowering therapeutic strategies in people with psychotic disorders and hyperprolactinaemia: 1) switching to prolactin-sparing antipsychotics; 2) adding aripiprazole; 3) adding dopamine agonists; and 4) adding metformin. RCTs were included in a meta-analysis. Effect sizes (Hedges' g) of prolactin reductions with each strategy were calculated. Withdrawal rates were also considered. We identified 26 studies. Nine studies explored switching antipsychotic treatment to aripiprazole (n = 4), olanzapine (n = 1), quetiapine (n = 2), paliperidone palmitate (n = 1) or blonanserin (n = 1). Twelve studies tested the addition of aripiprazole. Six studies explored the addition of cabergoline (n = 3), bromocriptine (n = 2) or terguride (n = 1). We also found one meta-analysis testing the addition of metformin to antipsychotic treatment but no other individual studies. A meta-analysis could only be performed for the addition of aripiprazole, the strategy with the best level of evidence. Five RCTs testing the addition of aripiprazole yielded a significant reduction in prolactin concentration compared to placebo (N = 3) or maintaining antipsychotic treatment (N = 2): Hedges' g was −1.35 (CI 95%: −1.93 to −0.76, p < 0.001). The three placebo-controlled RCTs for aripiprazole addition showed similar withdrawal rates for aripiprazole (10.1%) and placebo (11.5%), without significant differences in the meta-analysis. Our study suggests that, in terms of levels of evidence, adding aripiprazole is the first option to be considered for lowering prolactin concentrations in patients with schizophrenia and hyperprolactinaemia.
AB - Different therapeutic strategies are used for lowering prolactin concentrations in patients with psychotic disorders with antipsychotic-induced hyperprolactinaemia. We aimed to examine the evidence from open-label studies and randomized clinical trials (RCTs) that studied four prolactin-lowering therapeutic strategies in people with psychotic disorders and hyperprolactinaemia: 1) switching to prolactin-sparing antipsychotics; 2) adding aripiprazole; 3) adding dopamine agonists; and 4) adding metformin. RCTs were included in a meta-analysis. Effect sizes (Hedges' g) of prolactin reductions with each strategy were calculated. Withdrawal rates were also considered. We identified 26 studies. Nine studies explored switching antipsychotic treatment to aripiprazole (n = 4), olanzapine (n = 1), quetiapine (n = 2), paliperidone palmitate (n = 1) or blonanserin (n = 1). Twelve studies tested the addition of aripiprazole. Six studies explored the addition of cabergoline (n = 3), bromocriptine (n = 2) or terguride (n = 1). We also found one meta-analysis testing the addition of metformin to antipsychotic treatment but no other individual studies. A meta-analysis could only be performed for the addition of aripiprazole, the strategy with the best level of evidence. Five RCTs testing the addition of aripiprazole yielded a significant reduction in prolactin concentration compared to placebo (N = 3) or maintaining antipsychotic treatment (N = 2): Hedges' g was −1.35 (CI 95%: −1.93 to −0.76, p < 0.001). The three placebo-controlled RCTs for aripiprazole addition showed similar withdrawal rates for aripiprazole (10.1%) and placebo (11.5%), without significant differences in the meta-analysis. Our study suggests that, in terms of levels of evidence, adding aripiprazole is the first option to be considered for lowering prolactin concentrations in patients with schizophrenia and hyperprolactinaemia.
KW - Antipsychotics
KW - Aripiprazole
KW - Dopamine agonists
KW - Hyperprolactinaemia
KW - Schizophrenia
KW - Switching
UR - http://www.scopus.com/inward/record.url?scp=85085643488&partnerID=8YFLogxK
UR - https://www.mendeley.com/catalogue/ac0ca036-d81f-3a3d-b69e-4362f69a6387/
U2 - 10.1016/j.schres.2020.04.031
DO - 10.1016/j.schres.2020.04.031
M3 - Artículo de revisión
C2 - 32507371
AN - SCOPUS:85085643488
VL - 222
SP - 88
EP - 96
JO - Schizophrenia Research
JF - Schizophrenia Research
SN - 0920-9964
ER -
