BACKGROUND Behavioural and psychological symptoms of dementia (BPSD) are highly prevalent in people living with dementia. Second-generation antipsychotics (SGAs) are commonly used to treat BPSD, but their comparative efficacy and acceptability are unknown. METHODS The standard mean difference (SMD) was used to pool the fixed effects of continuous outcomes. We calculated ORs with corresponding 95% credible intervals (CI) for the categorical variable. Efficacy was defined as the scores improved on the standardised scales. Acceptability was defined as the all-cause dropout rate. Tolerability was defined as the discontinuation rate due to adverse effects (AEs). The relative treatment rankings were reported with the surface under the cumulative curve. The AE outcomes included mortality, cerebrovascular adverse events (CVAEs), falls, sedation, extrapyramidal symptoms and urinary symptoms. RESULTS Twenty randomised controlled trials with a total of 6374 individuals containing 5 types of SGAs (quetiapine, olanzapine, risperidone, brexpiprazole and aripiprazole) with intervention lengths ranging from 6 weeks to 36 weeks were included in this network meta-analysis. For the efficacy outcome, compared with the placebo, brexpiprazole (SMD=-1.77, 95% CI -2.80 to -0.74) was more efficacious, and brexpiprazole was better than quetiapine, olanzapine and aripiprazole. Regarding acceptability, only aripiprazole (OR=0.72, 95% CI 0.54 to 0.96) was better than the placebo, and aripiprazole was also better than brexpiprazole (OR=0.61, 95% CI 0.37 to 0.99). In terms of tolerability, olanzapine was worse than placebo (OR=6.02, 95% CI 2.87 to 12.66), risperidone (OR=3.67, 95% CI 1.66 to 8.11) and quetiapine (OR=3.71, 95% CI 1.46 to 9.42), while aripiprazole was better than olanzapine (OR=0.25, 95% CI 0.08 to 0.78). Quetiapine presented good safety in CVAE. Brexpiprazole has better safety in terms of falls and showed related safety in sedation among included SGAs. CONCLUSION Brexpiprazole showing great efficacy in the treatment of BPSD, with aripiprazole showing the highest acceptability and olanzapine showing the worst tolerability. The results of this study may be used to guide decision-making.

中文翻译：

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第二代抗精神病药物对痴呆症行为和心理症状的功效、可接受性和耐受性：系统评价和网络荟萃分析。


背景痴呆症的行为和心理症状（BPSD）在痴呆症患者中非常普遍。第二代抗精神病药 (SGA) 通常用于治疗 BPSD，但其相对疗效和可接受性尚不清楚。方法 使用标准均差（SMD）来汇总连续结果的固定效应。我们计算了 calcategories 变量与相应 95% 可信区间 (CI) 的 OR。功效被定义为标准化量表上分数的提高。可接受性定义为全因辍学率。耐受性定义为因不良反应 (AE) 导致的停药率。相对处理排名用累积曲线下的表面来报告。 AE 结局包括死亡率、脑血管不良事件 (CVAE)、跌倒、镇静、锥体外系症状和泌尿系统症状。结果 本网络荟萃分析纳入了 20 项随机对照试验，共 6374 名受试者，涉及 5 种 SGA（喹硫平、奥氮平、利培酮、布瑞哌唑和阿立哌唑），干预时间从 6 周到 36 周不等。就疗效结果而言，与安慰剂相比，brexpiprmaze（SMD=-1.77，95% CI -2.80至-0.74）更有效，且brexpiprmaze优于喹硫平、奥氮平和阿立哌唑。在可接受性方面，只有阿立哌唑（OR=0.72，95% CI 0.54至0.96）优于安慰剂，阿立哌唑也优于brexpiprmaze（OR=0.61，95% CI 0.37至0.99）。就耐受性而言，奥氮平差于安慰剂（OR=6.02，95% CI 2.87至12.66）、利培酮（OR=3.67，95% CI 1.66至8.11）和喹硫平（OR=3.71，95% CI 1.46至9.42） ，而阿立哌唑优于奥氮平（OR=0.25，95% CI 0.08 至 0.78）。喹硫平在 CVAE 中表现出良好的安全性。布雷哌唑在跌倒方面具有更好的安全性，并且在纳入的 SGA 中显示出相关的镇静安全性。结论 布瑞哌唑治疗 BPSD 疗效显着，其中阿立哌唑的可接受性最高，奥氮平的耐受性最差。这项研究的结果可用于指导决策。