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
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.
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.
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.
KeywordsGlucose Cholesterol Triglycerides Weight gain Medication-naïve Second-generation antipsychotic
This study was conducted as part of a clinical trial “Comparative Study of Aripiprazole, Quetiapine and Ziprasidone in the Treatment of First Episode Non-affective Psychosis (AZQ2005).” ClinicalTrials.gov Identifier: NCT02305823.
The authors wish to thank all “Programa Asistencial de las Fases Iniciales de Psicosis” (PAFIP) research team and all patients and family members who participated in the study.
BC-F designed the study and wrote the protocol. PSP evaluated the patients and collected the study variables. VO-G built and maintained the database and helped with the statistical analyses. RP-I and JV-B managed the literature searches. JV-B undertook the statistical analysis and wrote the first draft of the manuscript. ADM, RP-I, and BC-F contributed to the interpretation of the data and revised the manuscript critically. All authors contributed to and have approved the final manuscript.
The present study was carried out at the Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain, under the following grant support: Instituto de Salud Carlos III PI020499, PI050427, PI060507; Plan Nacional de Drogas Research Grant 2005-Orden sco/3246/2004; SENY Fundació Research Grant CI 2005–0308007; and Fundación Marqués de Valdecilla API07/011. Unrestricted educational and research grants from AstraZeneca, Pfizer, Bristol-Myers Squibb, and Johnson & Johnson provided support for PAFIP activities. No pharmaceutical industry or institutional sponsors participated in the study concept and design, data collection, analysis and interpretation of the results, and drafting the manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
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