Efficacy, tolerability and safety evaluation of atypical antipsychotics in the treatment of behavioral and psychological symptoms of dementia-a Bayesian network meta-analysis

Introduction: Atypical antipsychotics (AAPs) are commonly used for patients with behavioral and psychological symptoms of dementia (BPSD). But conclusion of efficacy, tolerability and safety is uncertainty. Hence, we compared the efficacy, tolerability and safty of AAPs for BPSD. Methods: We searched randomized controlled trials (RCTs). The primary outcome were the changes of Neuropsychiatric Inventory (NPI) total score, NPI-psychosis total score and the tolerability. The secondary outcome were the changes in the Brief Psychiatric Rating Scale (BPRS) total score, Cohen-Mansfield Agitation Inventory (CMAI) total score. We also evaluated 12 safety outcome measures. Then a Bayesian network meta-analyses was conducted. Results: There was no statistically significant difference between these AAPs and placebo or between AAPs either on effective outcome measures. Olanzapine had more worse tolerability, higher risk of CVAEs and EPSs, greater change of body weight compared with placebo. Risperidone had higher risk of EPSs and peripheral edema than placebo. Aripiprazole, olanzapine, quetiapine and risperidone all had higher risk of somnolence or sedation than placebo.. Conclusions: There is no absolutely effective, tolerability and safe AAPs for BPSD. Doctors should weigh the advantages and disadvantages of each AAPS, select the drugs individually and closely monitor the adverse reactions during the treatment.