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Aripiprazole for Patients with Bipolar Disorder: A Review of the Clinical Effectiveness, Cost-effectiveness and Guidelines

Last updated: May 25, 2016
Project Number: RC0780-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical efficacy of aripiprazole alone or as part of combination therapy for the treatment of bipolar disorder?
  2. What is the cost-effectiveness of aripiprazole alone or as part of combination therapy for the treatment of bipolar disorder?
  3. What are the evidence-based guidelines regarding the use of aripiprazole alone or as part of combination therapy for the treatment of bipolar disorder?

Key Message

In both the acute and stabilization phases, the efficacy of aripiprazole was generally superior to placebo, and similar to traditional drugs in adult or pediatric populations with bipolar disorder. The safety profile of aripiprazole was similar to other drugs in both phases in general, with a higher risk of developing activation symptoms with aripiprazole during the acute phase and similar risk during the stabilization phase. Compared to placebo, the risk of sedation, akathisia, and extrapyramidal symptoms was higher with aripiprazole while the risk of developing activation symptoms was similar between the two. The risk of hyperprolactinemia was similar compared to placebo and lower than traditional drugs during the stabilization phase. Treatment with aripiprazole was associated with the lowest all-cause medical costs compared with olanzapine, quetiapine, risperidone, or ziprasidone. Treatment of adverse events due to aripiprazole was less costly than olanzapine. Aripiprazole as monotherapy or as an adjunct was recommended as first line therapy for pharmacological treatment of acute mania, or as maintenance therapy for recent manic or mixed episodes (mania and depression), but not recommended for acute bipolar depression. Aripiprazole was suggested as moderately safe in women with lactation but its risk on pregnancy cannot be ruled out.