OBJECTIVES: Since publication of a systematic literature review (SLR) and network meta-analysis (NMA) comparing the efficacy and safety of lurasidone with atypical antipsychotic monotherapies for the treatment of acute bipolar depression among adults, new clinical trial data have been released. The purpose of this study was to update an NMA comparing the efficacy and safety of lurasidone with all other atypical antipsychotic monotherapies in adult patients with bipolar depression.

METHODS: A SLR and NMA of randomized controlled trials (RCTs) was updated as of August 2018 using Embase, MEDLINE, PsycINFO, Cochrane library, clinicaltrials.gov, recent abstracts, and press releases. Outcomes included the Montgomery–Åsberg Depression Rating Scale (MADRS), Clinical Global Impressions–Bipolar Disorder–Severity (CGI-BP-S) scale, weight gain, somnolence, akathisia, extrapyramidal symptoms (EPS), and all-cause discontinuation. Mean differences in change from baseline and mean odds ratios (OR) with 95% credible intervals were calculated.

RESULTS: Seventeen RCTs of lurasidone, quetiapine (IR or XR), aripiprazole, olanzapine, ziprasidone and cariprazine for the treatment of bipolar depression were included. Lurasidone was significantly more efficacious than cariprazine (MADRS: -2.91 [-5.57, -0.20], CGI-BP-S: -0.44 [-0.74, -0.14]), aripiprazole (MADRS: -3.62 [-6.89, -0.36], CGI-BP-S: -0.42 [-0.77, -0.07]), and ziprasidone (MADRS: -3.37 [-6.49, -0.23], CGI-BP-S: -0.59 [-0.93, -0.24]). Lurasidone had similar efficacy vs olanzapine and quetiapine. Lurasidone had less weight gain than olanzapine (-2.54kg [-3.36, -1.72]), quetiapine (-0.83kg [-1.55, -0.12]), and cariprazine (-0.40kg [-1.30, 0.49]), and less somnolence than ziprasidone (OR: 0.28 [0.09, 0.66]) and quetiapine (OR: 0.32 [0.11, 0.68]). Rates of akathisia, EPS, and all-cause discontinuation were similar.

CONCLUSIONS: Consistent with the previous NMA, lurasidone was efficacious and well-tolerated. The updated NMA showed lurasidone was more efficacious than cariprazine, aripiprazole, and ziprasidone among adults with acute bipolar depression. Lurasidone also had less weight gain than olanzapine and quetiapine, and less somnolence than quetiapine and ziprasidone.