The Acute Efficacy of Aripiprazole Across the Symptom Spectrum of Schizophrenia: A Pooled Post Hoc Analysis From 5 Short-Term Studies

Objective: To evaluate the efficacy of aripiprazole across a range of symptoms-positive, negative, disorganized thought, depression/anxiety, and hostility-in schizophrenia and schizoaffective disorder. Method: Pooled data were analyzed from 5 short-term, double-blind, multicenter studies (published between 1997 and 2007) involving patients hospitalized with acute exacerbation of schizophrenia (5 studies) or schizoaffective disorder (2 studies) and randomly assigned to aripiprazole (N = 875), haloperidol (N = 193), risperidone (N 95), or placebo (N = 406). Aripiprazole doses ranged from 2 to 30 mg/day. Patients receiving the ineffective 2-mg close were excluded from the primary analyses presented here. Factor analysis of Positive and Negative Syndrome Scale (PANSS) data was used to evaluate changes from baseline with aripiprazole on 5 symptom factors-positive. negative, disorganized thought, depression/anxiety, and hostility-in 2 population subsets-schizophrenia and schizoaffective disorder. Pairwise comparisons were made as follows for schizophrenia: aripiprazole versus placebo in all 5 studies; aripiprazole, haloperidol, and placebo in 3 studies; and aripiprazole, risperidone, and placebo in 1 study. Patients with schizoaffective disorder in 21 studies were included in the comparison of aripiprazole and placebo. Results: Aripiprazole was significantly better than placebo in improving all 5 PANSS factor scores from baseline (each p < .001) in the schizophrenia dataset. In schizoaffective disorder, aripiprazole was significantly better than placebo for the improvement of positive (p < .05) and hostility (p <= .01) factor scores. Analysis of the 3 studies involving haloperidol showed that aripiprazole was significantly better than placebo in improving all 5 factors (p <= .01). whereas haloperidol produced significantly greater improvements than placebo in 3 factors (positive, disorganized thought, and hostility) (each p <= .001). There was no difference between aripiprazole and haloperidol on any factor. Analysis of the study involving risperidone showed that both drugs were better than placebo for all 5 factors with the exception of the depression/anxiety factor, in which only risperidone separated from placebo. There was no difference between aripiprazole and risperidone on any factor. Conclusion: In this large dataset, aripiprazole was associated with improvements in a broad range of symptom domains in the short-term treatment of schizophrenia and schizoaffective disorder.