Effects of switching from olanzapine to aripiprazole on the metabolic profiles of patients with schizophrenia and metabolic syndrome: a double-blind, randomized, open-label study

Abstract

BackgroundPatients with schizophrenia suffer high rates of metabolic derangements on some antipsychotic medications that predispose them to cardiovascular diseases. Keeping this fact in mind, we planned this open-label study to see the effect on various metabolic parameters after switching stable schizophrenia subjects, who had developed metabolic syndrome on olanzapine, to aripiprazole.MethodsSixty-two patients with schizophrenia who were stable on olanzapine and were fulfilling modified National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP-III) criteria for the presence of metabolic syndrome were enrolled on the study. Patients were randomly assigned either to switch to aripiprazole or to stay on olanzapine, on a 1:1 basis. Cross-tapering over a period of 1 month was done while switching patients to aripiprazole. Laboratory assessment for metabolic parameters was done at baseline, 8 weeks, and 24 weeks after enrollment; efficacy assessment was done using the Positive and Negative Syndrome Scale (PANSS) at baseline and 24 weeks, the Clinical Global Impressions severity subscale (CGI-S) at baseline, and the Clinical Global Impressions improvement subscale (CGI-I) at 24 weeks.ResultsAll parameters of metabolic syndrome (waist circumference, blood pressure, triglyceride level, fasting blood glucose, and high-density lipoprotein cholesterol) kept deteriorating in the stay group, compared with a continuous improvement in the switch group over time. At the end of the study, 26 patients (100%) from the stay group and 15 patients (42.8%) from switch group met the modified NCEP ATP-III criteria for presence of metabolic syndrome (P<0.001). There were no statistically significant differences between groups in psychopathology changes as measured by the PANSS total score and CGI-I scores.ConclusionClinically stable patients with schizophrenia who are taking olanzapine and who have evidence of metabolic syndrome can be successfully switched to aripiprazole, with improvement in various parameters of metabolic syndrome and without any significant change in efficacy measures.

Long‐term effectiveness of oral second‐generation antipsychotics in patients with schizophrenia and related disorders: a systematic review and meta‐analysis of direct head‐to‐head comparisons

“…Altogether, we included 63 reports (59 randomized studies) with 45,787 participants (median: 255 participants/study, range: from 12 to 18,154) (Table ). The mean age of the population was 37.6±7.0 years; 62.1±13.3% were male and 61.1±28.8% were white.…”

The Effectiveness of Pharmacological and Non-Pharmacological Interventions for Improving Glycaemic Control in Adults with Severe Mental Illness: A Systematic Review and Meta-Analysis

“…Seven trials evaluated an intervention against usual care [47, 56, 61, 64, 68, 70, 73]. One study compared two interventions but did not include a control arm [44].…”

Tardive Dyskinesia Revisited-A Clinical Management Priority Perspective: A Voyage into High Dose Buspirone Part B

“…Several apparently are linked with metabolic syndrome (and the FGAs often also had those problems). One example is olanzapine, an example of a drug with know increased risks of weight gain and diabetes [204][205][206][207]. But the essence is whether the risk of tardive dyskinesia has been any lower or are some of the older typical neuroleptics like chlorpromazine in sedation and perphenazine as safe or safer because they are not selective for Dopamine 2 or Dopamine 2/3 receptors.…”