Aripiprazole not tied to psychiatric worsening in patients with previous antipsychotic exposure

  • Montastruc F & al.
  • JAMA Psychiatry
  • 30 Jan 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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  • Aripiprazole initiation was not associated with psychiatric treatment failure including psychiatric hospitalisation, self-harm or suicide vs another antipsychotic drug in patients previously exposed to antipsychotic medications.

Why this matters

  • Some studies have reported a higher incidence of potential psychiatric worsening in first-time users of aripiprazole who have previously received antipsychotic treatment.
  • Patients should, however, still be monitored when they switch to or add aripiprazole until current findings are confirmed in large studies.

Study design

  • Study of 1643 patients switching or adding aripiprazole (either as a switch from or add-on to a previous antipsychotic medication) and propensity-matched patients switching to or adding another antipsychotic medication during 2005-2015.
  • Funding: Canadian Institutes of Health Research and the Canadian Foundation for Innovation.

Key results

  • Follow-up duration, 2692 person-years.
  • 391 incident serious psychiatric treatment failures were observed (incidence rate of 14.52 per 100 person-years).
  • Initiation of aripiprazole vs another antipsychotic medication was not associated with an increased rate of:
    • psychiatric treatment failure (aHR, 0.87; 95% CI, 0.71-1.06);
    • psychiatric hospitalisation (aHR, 0.85; 95% CI, 0.69-1.06) and  
    • self-harm or suicide (aHR, 0.96; 95% CI, 0.68-1.36).
  • Psychiatric treatment failure was similar with aripiprazole vs another antipsychotic medication in:
    • patients who recently received antipsychotic medication (aHR, 0.87; 95% CI, 0.67-1.15) and
    • patients with schizophrenia (aHR, 0.82; 95% CI, 0.62-1.08).


  • Observational design.