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Pharmacological treatment strategies for lowering prolactin in people with a psychotic disorder and hyperprolactinaemia: A systematic review and meta-analysis.
Schizophr Res. 2020 Jun 02 [Online ahead of print]SR

Abstract

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.

Authors+Show Affiliations

Department of Mental Health, Hospital Universitari Parc Taulí, I3PT. Sabadell, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Cerdanyola, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain. Electronic address: jlabad@tauli.cat.Department of Mental Health, Hospital Universitari Parc Taulí, I3PT. Sabadell, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.Department of Mental Health, Hospital Universitari Parc Taulí, I3PT. Sabadell, Barcelona, Spain.Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Barcelona Clinic Schizophrenia Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Spain.Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; University Hospital Virgen del Rocío, IBiS, Departament of Psychiatry, University of Sevilla, Sevilla, Spain.Department of Mental Health, Hospital Universitari Parc Taulí, I3PT. Sabadell, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Cerdanyola, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.Department of Mental Health, Hospital Universitari Parc Taulí, I3PT. Sabadell, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Cerdanyola, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32507371

Citation

Labad, Javier, et al. "Pharmacological Treatment Strategies for Lowering Prolactin in People With a Psychotic Disorder and Hyperprolactinaemia: a Systematic Review and Meta-analysis." Schizophrenia Research, 2020.
Labad J, Montalvo I, González-Rodríguez A, et al. Pharmacological treatment strategies for lowering prolactin in people with a psychotic disorder and hyperprolactinaemia: A systematic review and meta-analysis. Schizophr Res. 2020.
Labad, J., Montalvo, I., González-Rodríguez, A., García-Rizo, C., Crespo-Facorro, B., Monreal, J. A., & Palao, D. (2020). Pharmacological treatment strategies for lowering prolactin in people with a psychotic disorder and hyperprolactinaemia: A systematic review and meta-analysis. Schizophrenia Research. https://doi.org/10.1016/j.schres.2020.04.031
Labad J, et al. Pharmacological Treatment Strategies for Lowering Prolactin in People With a Psychotic Disorder and Hyperprolactinaemia: a Systematic Review and Meta-analysis. Schizophr Res. 2020 Jun 2; PubMed PMID: 32507371.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pharmacological treatment strategies for lowering prolactin in people with a psychotic disorder and hyperprolactinaemia: 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, Y1 - 2020/06/02/ PY - 2020/01/23/received PY - 2020/04/19/revised PY - 2020/04/22/accepted PY - 2020/6/9/entrez KW - Antipsychotics KW - Aripiprazole KW - Dopamine agonists KW - Hyperprolactinaemia KW - Schizophrenia KW - Switching JF - Schizophrenia research JO - Schizophr. Res. 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. SN - 1573-2509 UR - https://www.unboundmedicine.com/medline/citation/32507371/Pharmacological_treatment_strategies_for_lowering_prolactin_in_people_with_a_psychotic_disorder_and_hyperprolactinaemia:_A_systematic_review_and_meta-analysis L2 - https://linkinghub.elsevier.com/retrieve/pii/S0920-9964(20)30238-3 DB - PRIME DP - Unbound Medicine ER -
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