Asenapine for aggressive behaviours in psychiatric disorders: a systematic review of efficacy and real-world effectiveness

Abstract

Background Clinical decision-making for the pharmacological treatment of aggressive behaviour in psychiatry remains challenging. Asenapine, a second-generation antipsychotic with a higher affinity for dopamine D4 than for D2 receptors, may become a treatment option, although this remains to be demonstrated.

Methods A systematic search was conducted across biomedical databases according to PRISMA Reporting Items for Systematic Review. We aimed to examine the efficacy and effectiveness of asenapine in the management of aggressive behaviours including psychomotor agitation, hostility, irritability, anger, impulsivity, self-harm, behavioural disinhibition, as well as physical and verbal aggression, across psychiatric disorders.

Results Of the 12 studies included, four reported asenapine’s efficacy in aggressive behaviours compared to placebo, and five described the effectiveness in uncontrolled settings. Three studies found no advantages over olanzapine. Major evidence supports asenapine’s efficacy in reducing psychomotor agitation and hostility, with benefits independent of its anti-manic and antipsychotic effects.