Borderline personality disorder (BPD) is characterized by unstable interpersonal relationships, emotion and self-image, as well as marked impulsivity causing significant impairment.¹ The term BPD describes a disease in the “borderline” between psychosis and neurosis.² In the United States, it was reported in 2008 that the estimated prevalence was 1.4 percent in general population,¹ but may be as high as 20% among psychiatry inpatients. BPD is predominantly (75%) diagnosed in women in clinical settings.^1,2 However, there is no significant difference in the lifetime prevalence of BPD between men and women. This discrepancy of gender prevalence suggests that women with BPD are more likely to seek treatment than men.¹ Co-morbidity with other psychiatric disorders is common in patients with BPD, especially with mood, anxiety, substance-use, and eating disorders. The cause of BPD is not known. Most hypotheses suggest that BPD is due to a combination of genetic, biologic, and psychosocial factors.¹ Patients may experience spontaneous intermittent remission clinically sometimes. It is estimated that about 60% to 78% of BPD patients make suicide attempts, but the rate of completed suicides was found to be about 4% during a 10-years follow-up. An estimated lifetime risk of suicide of patients with BPD ranged from 3% to 10 %.² The clinical diagnosis of BPD is based on a comprehensive psychiatric assessment. Clinicians use all available sources of information to make the diagnosis including the patient’s self-reported clinical history, the clinician’s observations during interviews, and information from family, friends, and medical records. Children or young adolescents are generally not diagnosed with BPD.^1,3

The first-line treatment for BPD is psychotherapy.³ Pharmacotherapy is usually used as adjuncts to psychotherapy for treatment specific BPD symptoms clinically.³ The medications used for BPD include antipsychotics, mood stabilizer, and antidepressants.³ It has been observed that pharmacotherapy only partially reduces symptoms, including lability, inappropriate anger, dysphoria, impulsivity, aggression towards self and others, dissociation, disturbed identity, paranoia and interpersonal problems.¹ Little published data indicates how long an effective medication for BPD should be continued.³ Antipsychotics have been found to reduce BPD symptoms including aripiprazole (mean daily dose: 15 mg); ziprasidone (mean daily dose: 20 to 80 mg), olanzapine (mean daily dose: 5 to 9 mg, daily dose range 5 to 20 mg), haloperidol (mean daily dose 5 mg, daily dose range 4 to 16 mg), Quetiapine XL (at a daily dose of 150 mg).³

Aripiprazole is indicated for the treatment of schizophrenia and related psychotic disorders in adults.⁴ In the literature, it is indicated that, in the United States, the Food and Drug Administration (FDA) has not approved any medications for treatment of BPD.³ Aripiprazole is not currently approved by the FDA³ or Health Canada⁴ for the treatment of BPD. The empirically use of antipsychotics in patients with BPD are considered as off-label use.^3,5 In the literature, it has been reported that clinical trials have not been adequate to examine the efficacy of antipsychotics in BPD.³ Results have been variable and inconclusive. This document aims to review the clinical effectiveness and safety profile of aripiprazole in the treatment of patients with BPD.

Contents

• RESEARCH QUESTION
• KEY FINDINGS
• METHODS
  • Literature Search Methods
  • Selection Criteria and Methods
  • Exclusion Criteria
  • Critical Appraisal of Individual Studies
• SUMMARY OF EVIDENCE
  • Quantity of Research Available
  • Summary of Study Characteristics
  • Summary of Critical Appraisal
  • Summary of Findings
  • Limitations
• CONCLUSIONS AND IMPLICATIONS FOR DECISION OR POLICY MAKING
• REFERENCES
• APPENDIX 1. Selection of Included Studies
• APPENDIX 2. Characteristics of Included Publications
• APPENDIX 3. Summary of Study Strengths and Limitations
• APPENDIX 4. Main Study Findings and Authors’ Conclusions

PREPARED BY:

Canadian Agency for Drugs and Technologies in Health

Tel: 1-866-898-8439

www​.cadth.ca

Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic review s. The intent is to provide a list of sources of the best evidence on the topic that the Canadian Agency for Drugs and Technologies in Health (CADTH) could identify using all reasonable efforts within the time allow ed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report.