Antipsychotics Can Increase Metabolic Risk Factors

Article excerpt

Since their introduction in the 1990s, atypical antipsychotics have become the drugs of choice for the treatment of schizophrenia. However, these drugs are associated with a high incidence of weight gain or other metabolic side effects, influencing glucose and lipid metabolism.

"The metabolic effects associated with drugs in this class are a significant concern, because schizophrenia patients have an increased prevalence of metabolic risk factors, which are often exacerbated by certain atypical antipsychotics," stated Jason M. Noel, Pharm.D., BCPP, assistant professor of pharmacy practice, University of Maryland School of Pharmacy, during a recent teleconference that examined clinical solutions to metabolic issues. This has been demonstrated in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) as well as in other studies. The teleconference was sponsored by Pfizer.

Additionally, patients with chronic mental illnesses have been found to be associated with a higher mortality rate than people in the general population. "Our patients are the sickest and the least likely to receive care. We have a serious problem with respect to morbidity and mortality. There are evidence-based data that this problem is there and the public sector needs to act," added Henry Nasrallah, M.D., professor of psychiatry and neuroscience, University of Cincinnati College of Medicine.

CATIE was an 18-month study funded by the National Institute of Mental Health comparing perphenazine with atypical antipsychotics-olanzapine (Zyprexa, Lilly), quetiapine (Seroquel, AstraZeneca), risperidone (Risperdal, Janssen), or ziprasidone (Geodon, Pfizer)-in 1,460 people with schizophrenia. The baseline data collected during the study demonstrated the prevalence of diabetes, hyperlipidemia, hypertension, and obesity (defined as a BMI of 30 or more) in schizophrenia patients and addressed the concerns about undertreatment in this population. The prevalence of these comorbid conditions is higher than in the eeneral Dooulation.

CATTE shed some insights about the fact that antipsychotic selection is not a straightforward process. All study medications showed significant improvements on the Positive & Negative Syndrome Scale (PANSS). Olanzapine had favorable efficacy but worse metabolic side effects compared with other drugs in CATTE," stated Ryan Carnahan, Pharm. …