Aripiprazole in the treatment of Alzheimer's disease
Aripiprazole in the treatment of Alzheimer's disease
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DOI：
10.1517/14656566.2013.764989
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发表时间：
2013-03-01
影响因子：
3.2
通讯作者：
Van Dam, Debby
中科院分区：
文献类型：
--
作者：
De Deyn, Peter Paul;Drenth, Annemieke F. J.;Van Dam, Debby
前言：精神病是阿尔茨海默病（AD）中常见且难治的症状。这是生活质量下降和护理人员痛苦的原因。非典型抗精神病药物经常用于治疗痴呆相关的精神病，尽管FDA警告，因为在痴呆患者中使用这些药物会增加死亡率。阿立哌唑是一种较新的非典型抗精神病药物，在多巴胺受体和拮抗剂活性在5-HT 2A受体的部分激动剂活性，具有低的副作用profile.Areas covered：这种描述性的审查提供了一个简短的概述AD的病理学和流行病学，包括精神病症状，并描述了阿立哌唑的作用模式和临床前研究的结果。最后，随机对照试验评估阿立哌唑在AD相关精神病和激越的使用进行了讨论。无论何时相关，荟萃分析数据从文学reference.Expert意见：在随机安慰剂对照临床试验，阿立哌唑显示适度的疗效在AD相关精神病的治疗。神经精神症状缓解主要是精神病性和激越。在个体试验中，阿立哌唑通常耐受良好，很少报告严重副作用，包括意外伤害和嗜睡。然而，荟萃分析表明，死亡率增加是非典型抗精神病药物的类效应，也是典型抗精神病药物的类效应。在荟萃分析中，阿立哌唑治疗的痴呆精神病患者的心血管结局、脑血管意外、食欲增加或体重增加均未增加。发现阿立哌唑可诱导镇静。阿立哌唑应仅用于对非药物治疗耐药、持续或重度精神病症状和/或激越的选定患者人群，并且这些症状会导致显著的发病率、患者痛苦和潜在的自我伤害。应定期修订继续治疗的适应症。
Introduction: Psychosis is a common and difficult to treat symptom in Alzheimer's disease (AD). It is a cause of diminished quality of life and care-giver distress. Atypical antipsychotics are frequently used for the treatment of dementia-related psychosis, despite FDA warnings because of increased mortality associated with the use of these medications in dementia patients. Aripiprazole is a newer atypical antipsychotic drug with partial agonist activity at dopamine receptors and antagonist activity at 5-HT2A receptors, with a low side-effect profile.Areas covered: This descriptive review gives a short overview of the pathology and epidemiology of AD, including psychotic symptoms, and describes the mode of action of aripiprazole and results of preclinical studies. Finally, randomized controlled trials evaluating the use of aripiprazole in AD-related psychosis and agitation are discussed. Whenever relevant, meta-analytical data from literature are referred to.Expert opinion: In randomized placebo-controlled clinical trials, aripiprazole shows modest efficacy in the treatment of AD-related psychosis. Neuropsychiatric symptoms alleviated were predominantly psychotic features and agitation. In individual trials, aripiprazole was generally well tolerated, serious side effects were seldom reported and included accidental injury and somnolence. Meta-analyses however demonstrated increased mortality as a class effect for atypical, but also for typical antipsychotics. No increased cardiovascular outcomes, cerebrovascular accidents, increased appetite or weight gain were demonstrated in meta-analyses for aripiprazole-treated patients with psychosis of dementia. Aripiprazole was found to induce sedation. Aripiprazole should only be used in selected patient populations resistant to non-pharmacological treatment with persisting or severe psychotic symptoms and/or agitation, and in which symptoms lead to significant morbidity, patient suffering and potential self-harm. The indication for continuing treatment should be revised regularly.