title: Adjunctive Brexpiprazole as a Novel Effective Strategy for Treating Major Depressive Disorder: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  Brexpiprazole was approved for adjunctive treatment of major depressive disorder (MDD) in 2015. Because only a small number of randomized controlled trials have investigated the use of brexpiprazole in MDD, we performed a meta-analysis.
  
  
  METHODS
  We systematically searched literatures in PubMed, Cochrane Library database, EMBASE, Google Scholar, and clinicaltrials.gov up to January 2016. The primary efficacy measure was the mean change in total Montgomery-Åsberg Depression Rating Scale (MADRS) score from baseline. Secondary efficacy measures were the mean change in total Hamilton Rating Scale for Depression (17 items) score from baseline and the response (≥50% reduction in MADRS total score) and remission (MADRS total score ≤ 10 with ≥50% reduction) rates.
  
  
  RESULTS
  Four studies fulfilled the inclusion criteria and were included in the analysis. Brexpiprazole showed superior efficacy over placebo with effect sizes (mean differences) of -1.76 (95% confidence interval [CI], -2.45 to -1.07) for MADRS and -1.21 (95% CI, -1.71 to -0.72) for the 17-item Hamilton Rating Scale for Depression. The risk ratios for response and remission were 1.57 (95% CI, 1.29-1.91) and 1.55 (95% CI, 1.22-1.96), respectively. The incidences of discontinuation due to adverse events, akathisia, and weight increase were higher in the brexpiprazole group than in the placebo group, with risk ratios of 3.44 (95% CI, 1.52-7.80), 3.39 (95% CI, 2.08-5.51), and 4.36 (95% CI, 2.45-7.77), respectively, and the incidence of akathisia was related to the brexpiprazole dose.
  
  
  CONCLUSIONS
  Although our results suggest that brexpiprazole could be an effective adjunctive agent for MDD, they should be cautiously translated into clinical practice because the meta-analysis was based on only a handful of randomized controlled trials.
authors.affiliation: From the *Department of Psychiatry, Korea University College of Medicine, Seoul, Korea; †Department of Psychiatry and Behavioural Sciences, Duke University Medical Center, Durham, NC; ‡Academic Medicine Education Institute, Duke-NUS Medical School, Singapore; and §Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Seoyoung
authors.initials: S
authors.lastname: Yoon
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Jeon
authors.forename: Young-Hoon
authors.initials: YH
authors.lastname: Ko
authors.forename: Ashwin A
authors.initials: AA
authors.lastname: Patkar
authors.forename: Prakash S
authors.initials: PS
authors.lastname: Masand
authors.forename: Chi-Un
authors.initials: CU
authors.lastname: Pae
authors.forename: Changsu
authors.initials: C
authors.lastname: Han
mesh_terms: D003865:Major Depressive Disorder / Q000188:drug therapy*; D006801:Humans; D015363:Quinolones / Q000008:administration & dosage / Q000494:pharmacology*; D018490:Serotonin Agents / Q000008:administration & dosage / Q000494:pharmacology*; D013876:Thiophenes / Q000008:administration & dosage / Q000494:pharmacology*
chemical_list: D015363:Quinolones; D018490:Serotonin Agents; D013876:Thiophenes; C000591922:brexpiprazole