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01 - EFEITOS METABÓLICOS DO USO PROLONGADO DE ARIPIPRAZOL EM PACIENTES COM ESQUIZOFRENIA E PRIMEIRO EPISÓDIO PSICÓTICO: UMA REVISÃO SISTEMÁTICA E META-ANÁLISE

Doi: 10.47094/XCESMED.2026/1

PALAVRAS CHAVE: Não informadas.

KEYWORDS: Not reported.

ABSTRACT:
INTRODUCTION: Schizophrenia and first-episode psychosis (FEP) are severe mental disorders requiring prolonged antipsychotic treatment. Aripiprazole, a second-generation antipsychotic, has been associated with a low risk of short-term adverse metabolic effects, such as weight gain and dyslipidemia; however, its long-term impact remains uncertain. This gap underscores the need for systematic long-term studies to guide clinical practice. OBJECTIVES: This systematic review and meta-analysis aims to address the scarcity of studies evaluating the long-term metabolic effects of aripiprazole in patients with schizophrenia and FEP. METHODOLOGY: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the study was registered on the PROSPERO platform (ID: CRD4202563245). A search of the MEDLINE, Embase, and Cochrane Central databases was conducted independently by two authors in December 2025. The search strategy was: (schizophrenia OR “Schizophrenic Disorder” OR “first episode psychosis” OR FEP) AND (aripiprazole OR Abilify). Randomized clinical trials with at least one year of follow-up were included. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and statistical analyses were performed using Review Manager. RESULTS: The initial search identified 5,749 studies. After removing duplicates and applying eligibility criteria, six studies were included, totaling 2,666 patients. Regarding weight gain, statistically significant differences were observed between aripiprazole and other antipsychotics (MD = 0.77 kg; 95% CI: 0.16–1.37; p = 0.01; I² = 0%). However, a small effect size was found (Hedges’ g = 0.13; 95% CI: 0.02–0.24; p = 0.01; I² = 0%), suggesting a difference of low clinical impact. Furthermore, no significant differences were found between groups regarding BMI (MD = 1.27 kg/m²; 95% CI: –1.05 to 3.59; p = 0.28; I² = 92%) and cholesterol (MD = 3.52 mg/dL; 95% CI: –3.94 to 10.97; p = 0.28; I² = 0%). High heterogeneity in BMI indicates significant variability across studies—possibly due to differences in follow-up, dosage, and comparators—limiting interpretation. Sensitivity analyses showed that removing one study reduced this heterogeneity from 92% to 77% (p = 0.74). In the subgroup analysis, patients with PEP showed no statistically significant differences in weight gain with aripiprazole. Results should be interpreted with caution due to the moderate risk of bias, high heterogeneity, and limited number of included studies. CONCLUSION: Findings indicate a similar metabolic profile between aripiprazole and other antipsychotics during long-term use. Although there is a statistically significant difference in weight gain, its magnitude is small and of uncertain clinical relevance. High heterogeneity and the limited number of studies necessitate caution in interpretation.

Autores

  • Amarildo Lemos Dias de Moura

  • Gabriella Ficher de Assis Faria

  • Gustavo Hayasaki Vieira

  • Maria Laura Abrão Morais

  • Paulo Gontijo de Paiva Lima Duarte

  • Víctor Assis Alves

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