Long-term metabolic effects of aripiprazole, ziprasidone and quetiapine: a pragmatic clinical trial in drug-naïve patients with a first-episode of non-affective psychosis

• Published in: Psychopharmacology Vol. 235; no. 1; pp. 245 - 255
• Main Authors: Vázquez-Bourgon, Javier, Pérez-Iglesias, Rocío, Ortiz-García de la Foz, Víctor, Suárez Pinilla, Paula, Díaz Martínez, Álvaro, Crespo-Facorro, Benedicto
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 2018; Springer Nature B.V
• Subjects: Adult; Antidepressants; Antipsychotic Agents - adverse effects; Antipsychotic Agents - pharmacology; Antipsychotic Agents - therapeutic use; Antipsychotics; Aripiprazole; Aripiprazole - adverse effects; Aripiprazole - pharmacology; Aripiprazole - therapeutic use; Biomedical and Life Sciences; Biomedicine; Blood Glucose - drug effects; Body mass; Body Mass Index; Body Weight - drug effects; Cholesterol; Cholesterol - metabolism; Clinical trials; Dibenzothiazepines - therapeutic use; Female; High density lipoprotein; Humans; Hypercholesterolemia; Hypertriglyceridemia; Low density lipoprotein; Male; Mental disorders; Metabolism; Middle Aged; Neurosciences; Obesity; Original Investigation; Pharmacology/Toxicology; Piperazines - adverse effects; Piperazines - pharmacology; Piperazines - therapeutic use; Psychiatry; Psychopharmacology; Psychosis; Psychotic Disorders - drug therapy; Psychotic Disorders - metabolism; Psychotropic drugs; Quetiapine; Quetiapine Fumarate - adverse effects; Quetiapine Fumarate - pharmacology; Quetiapine Fumarate - therapeutic use; Quinolones - therapeutic use; Thiazoles - adverse effects; Thiazoles - pharmacology; Thiazoles - therapeutic use; Triglycerides; Triglycerides - metabolism; Young Adult; Ziprasidone; Second-generation antipsychotic; Medication-naïve; Triglycerides; Glucose; Weight gain; Cholesterol
• ISSN: 0033-3158; 1432-2072
• DOI: 10.1007/s00213-017-4763-x

Introduction The use of second-generation antipsychotics (SGA) has been associated with metabolic changes. However, there are differences in the metabolic profile between SGAs. We have previously observed that ziprasidone had a more benign early metabolic profile compared to aripiprazole and quetiapine. However, a long-term follow-up is preferred to detect clinically relevant impairment in metabolic parameters. We aimed to compare the effect of aripiprazole, ziprasidone, and quetiapine on metabolic measures in first-episode non-affective psychosis patients after 1 year of treatment. Material and methods One hundred and sixty-five drug-naïve patients, suffering from a first episode of non-affective psychosis, were randomly assigned to receive quetiapine, ziprasidone, or aripiprazole. Weight and glycemic/lipid parameters were recorded at baseline and after 1 year of treatment. Results After 1 year of antipsychotic treatment, we found significant increments in weight, BMI, total cholesterol, LDL-cholesterol, triglycerides, and the triglyceride/HDL index in the sample as a whole. These changes produced a significant rise in the percentage of patients with obesity, hypercholesterolemia, and hypertriglyceridemia. However, when comparing the differential effect of each antipsychotic medication, we found no significant differences in any of the metabolic parameters between antipsychotics groups after 1 year of treatment. Conclusion We concluded that the antipsychotics studied present similar metabolic profiles. However, the primary exposure to SGAs during the first year of psychosis was associated with significant increases in weight and metabolic parameters, leading to increments in obesity, hypertriglyceridemia, and hypercholesterolemia.