Efficacy and tolerability of brexpiprazole augmentation of SSRI therapy in PTSD: A systematic review and meta-analysis of randomized controlled trials.

Selective-serotonin re-uptake inhibitors (SSRIs) remain the primary pharmacotherapy for post-traumatic stress disorder (PTSD), yet 50 % of patients achieve insufficient symptomatic relief. Brexpiprazole, a serotonin-dopamine modulator, has emerged as a potential SSRI adjunct, but its benefit-risk profile has not been fully characterized. We searched PubMed, Europe PMC, Web of Science, EMBASE, Cochrane CENTRAL, PsycINFO, EBSCO and ClinicalTrials.gov for randomized-controlled trials (RCT) comparing BRX + SSRI with SSRI ± placebo among PTSD patients. Efficacy was assessed with the CAPS-5 and CGI-S scales, whereas safety was evaluated through rates of weight gain, metabolic laboratory changes, somnolence and any TEAE. Four RCT with 981 patients (51.3 % receiving BRX) met inclusion. Follow-up ranged from 8 to 12 weeks. Statistically significant improvement in CAPS-5 was observed in the BRX + SSRI versus SSRI ± placebo group (MD -3.77; 95 %CI -6.79 to -0.75; p = 0.01). However, pooled CGI-S deemed no statistically significant difference (MD -0.15; 95 %CI -0.33 to 0.04; p = 0.12). In the safety assessment, BRX increased body weight (MD 1.47; 95 %CI 0.84 to 2.09; p < 0.01) and somnolence (RR 2.39; 95 %CI 1.03 to 5.57; p = 0.04). However, the overall incidence of any treatment-emergent adverse event (TEAE) did not differ between the BRX and the control group (RR 0.77; 95 %CI 0.31 to 1.88; p = 0.56). Similarly, metabolic laboratory parameters showed no statistically different results in TGL (MD 2.95; 95 %CI -6.70 to 12.60; p = 0.55). In this meta-analysis, BRX augmentation significantly improved CAPS-5 scores but not CGI-S. Somnolence and weight gain were more frequent, with no changes in metabolic labs. Larger, longer-term RCTs are needed to confirm these findings.