Effect of lurasidone versus olanzapine on cardiometabolic parameters in unmedicated patients with schizophrenia: a randomized controlled trial

• Published in: Psychopharmacology Vol. 237; no. 11; pp. 3471 - 3480
• Main Authors: Jena, Monalisa, Mishra, Archana, Mishra, Biswa Ranjan, Nath, Santanu, Maiti, Rituparna
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2020; Springer; Springer Nature B.V
• Subjects: Adult; Antipsychotic Agents - adverse effects; Antipsychotic Agents - therapeutic use; Antipsychotics; Biomedical and Life Sciences; Biomedicine; Blood glucose; Blood Glucose - drug effects; Blood Glucose - metabolism; Cardiovascular diseases; Cardiovascular Diseases - blood; Cardiovascular Diseases - chemically induced; Cardiovascular Diseases - epidemiology; Care and treatment; Comparative analysis; Dosage and administration; Female; Follow-Up Studies; High density lipoprotein; Humans; Insulin; Lipids; Lipids - blood; Lurasidone Hydrochloride - adverse effects; Lurasidone Hydrochloride - therapeutic use; Male; Mental disorders; Metabolic Diseases - blood; Metabolic Diseases - chemically induced; Metabolic Diseases - epidemiology; Middle Aged; Morbidity; Neurosciences; Olanzapine; Olanzapine - adverse effects; Olanzapine - therapeutic use; Original Investigation; Patients; Pharmacology/Toxicology; Psychiatry; Risk factors; Schizophrenia; Schizophrenia - blood; Schizophrenia - drug therapy; Treatment Outcome; Young Adult; India; Atherogenic index; Lurasidone; Olanzapine; Cardiovascular risk index; Coronary risk index
• ISSN: 0033-3158; 1432-2072
• DOI: 10.1007/s00213-020-05628-3

Objective Patients with schizophrenia are at higher risk of cardiovascular morbidity and mortality than healthy individuals. This study was conducted to compare the effect of lurasidone and olanzapine on cardiometabolic parameters in unmedicated patients with schizophrenia. Methods The present study was a randomized open-label, parallel design, active-controlled clinical trial. After recruitment and randomization of 101 patients, a baseline assessment was done by PANSS, SOFAS, lipid profile, fasting blood glucose, HbA 1c , serum insulin and serum hs-CRP. HOMA-IR, atherogenic index, coronary risk index and cardiovascular risk indices were calculated as derived parameters. Patients received either lurasidone 80 mg or olanzapine 10 mg as monotherapy and followed up after 6 weeks. Results There was a significant increase in fasting blood glucose ( p < 0.001), HbA 1c ( p < 0.001) and serum insulin ( p < 0.001) after 6 weeks of therapy in both the treatment groups but the difference between the groups was not significant (FBS, p = 0.209; HbA1c, p = 0.209; serum insulin, p = 0.720). Olanzapine showed worsening of lipid profile ( p < 0.001) while the same improved with lurasidone ( p < 0.001) and the difference between the groups was found to be significant ( p < 0.001). Serum HDL level decreased in both the treatment groups (olanzapine, p < 0.001; lurasidone, p < 0.001) but the difference between the groups was not significant ( p = 0.333). There was an increase in hs-CRP levels in both the treatment groups (olanzapine, p < 0.001; lurasidone, p < 0.001) with no significant difference between them ( p = 0.467). Atherogenic index, coronary risk index and cardiovascular risk index increased significantly in the olanzapine group as compared with the lurasidone group ( p < 0.001). Conclusion Lurasidone showed a favourable effect on lipid profile and cardiovascular risk indices over olanzapine. However, long-term studies are needed to establish and generalize the findings. Trial registration ClinicalTrials.gov NCT03304457