Lipid Disturbances in Adolescents Treated With Second-Generation Antipsychotics

Abstract

Objective: Lipid disturbances following treatment with second-generation antipsychotics (SGA) represent a major health concern. A previous study determined that early changes of plasma lipid levels ≥5% during the first month of treatment with SGA predicts further lipid worsening and development of dyslipidemia. This study aimed to determine the proportion of adolescents with early lipid changes ≥5% and who develop dyslipidemia during SGA treatment. Methods: Data were obtained from a 1-year longitudinal study ongoing since 2007 including 53 adolescent psychiatric (ICD-10) patients (median 16.5 years; IQR: 14.8-17.5 years) whose metabolic parameters were monitored prospectively during treatment. Plasma lipid levels (total (TC), low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), and fasting triglycerides (TG)) were measured at baseline and after 1, 3 and/or 12 months of SGA treatment. Results: Half (n=26; 49%) of adolescents had early increase of TC levels by 5% or more during the first month of treatment and one third (n=8; 33%) developed new-onset hypercholesterolemia during the first year of treatment. Hypercholesterolemia developed more frequently in female patients (p = 0.01) and in patients with an early increase of total cholesterol ≥5% (p = 0.02). Finally, patients whose HDL-C levels decreased by ≥5% during the first month of treatment had a larger HDL-C worsening after three months of treatment as compared to others (p = 0.02). Conclusion: This study reminds the importance to monitor metabolic parameters prospectively also in adolescents after the introduction of SGAs. Author contributions CBE had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design was provided by CBE. AD, FV, AG, CD, AL, MGR, LH, AEA, PC, and CBE were involved in data acquisition. Statistical analysis and interpretation were provided by AD. Drafting of the manuscript was provided by AD. Critical revision of the manuscript for important intellectual content was provided by all authors. CBE and PC obtained funding for the study. Administrative, technical, or material support were provided by PC and CBE. All authors gave their approval for the present article.