Management of Adverse Effects of Second-generation Antipsychotics in Youth

Abstract

Opinion statementSecond-generation antipsychotics (SGAs) have been proven effective in treating several psychiatric conditions in children and adolescents. These atypical antipsychotic medications are being used with increasing frequency in Europe, the U.S., and Canada. We aim to expose shortterm and long-term adverse effects (AEs) of SGAs in youth populations and to provide management recommendations for major adverse effects. These proposals are based on (1) an indepth literature review of both short-and long-term studies on the use of SGAs in youth; (2) our own clinical experience in managing such treatment in this population; and (3) the work of the Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children (CAMESA). AEs are frequent in youth treated with SGAs, and include primarily weight gain, metabolic and hormonal changes, somnolence, extrapyramidal syndrome, and QT modifications. However, frequency and type of AE vary according to compound, and each compound's AE profile is specific. Acknowledgment of these distinct profiles should aid clinicians in making treatment decisions. After an SGA is prescribed, routine monitoring of AEs is recommended, and should an AE occur, clinical management recommendations should be followed. To date, there are no clinically validated monitoring recommendations.

Long-Term Metabolic Effects in French-Canadian Children and Adolescents Treated with Second-Generation Antipsychotics in Monotherapy or Polytherapy: A 24-Month Descriptive Retrospective Study

“…Moreover, 25.8% of the patients in our SGA polytherapy group were treated with aripiprazole (only 1.7% in monotherapy), while in McIntyre and Jerrell's 24 cohort, SGAs with a lower metabolic impact, such as aripiprazole or ziprasidone, were only marginally used (less than 5% of the subjects). 25,27,28 Our results overall show that, after 24 months of SGA therapy, there is a significant increase in mean weight, BMI z score, and FG level; in addition, a notable number of subjects developed obesity or a clinically significant increase in their BMI z score. When compared with the results of a recent prospective study in youth treated for 12 months with risperidone or quetiapine, 29 our results show similar weight gain but less of an increase in FG, as well as fewer newly developed metabolic complications, suggesting a more favourable 24-month evolution of the metabolic complications than at 12 months.…”

“…Moreover, 25.8% of the patients in our SGA polytherapy group were treated with aripiprazole (only 1.7% in monotherapy), while in McIntyre and Jerrell’s 24 cohort, SGAs with a lower metabolic impact, such as aripiprazole or ziprasidone, were only marginally used (less than 5% of the subjects). 25,27,28…”

Characteristics of voluntary reporting of adverse drug events related to antipsychotics in Australia: 14-year analysis

“…Appropriate recognition and management of these adverse events by healthcare professionals is warranted. 32 …”

Long-Term Metabolic Monitoring of Youths Treated with Second-Generation Antipsychotics 5 Years after Publication of the CAMESA Guidelines Are We Making Progress? Surveillance Métabolique à Long Terme des Jeunes Traités par Antipsychotiques de Deuxième Génération, Cinq ans Après la publication des Lignes Directrices Camesa: Faisons-Nous des Progrès?

“…2 Olanzapine and clozapine carry a high risk, quetiapine and risperidone a moderate risk, and aripiprazole and ziprasidone a low but non-negligible risk. 4,[14][15][16][17][18][19][20] Metabolic adverse effects (AEs), including weight gain, dyslipidemia, hyperglycemia, type 2 diabetes, and metabolic syndrome, may be more pronounced in the pediatric than in the adult population. 21 Metabolic disturbances in childhood and adolescence are well established risk factors for further cardiovascular morbidity and mortality in adulthood.…”