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Metabolic risk with second-generation antipsychotic treatment: a double-blind randomized 8-week trial of risperidone and olanzapine.
Ann Clin Psychiatry. 2008 Apr-Jun; 20(2):71-8.AC

Abstract

BACKGROUND

The second-generation antipsychotics are effective for treating psychotic disorders and incur fewer motor side effects than are commonly experienced with the use of first-generation antipsychotics. However, their use is commonly associated with weight gain and metabolic disturbances. This study examined weight and metabolic changes with two widely used antipsychotics, risperidone and olanzapine; addressing the issue of early monitoring for metabolic side effects.

METHODS

This 8-week double blind randomized trial included patients with schizophrenia or schizoaffective disorder (N = 377) randomly assigned to risperidone (2-6 mg/day) or olanzapine (5-20 mg/day). Weight, BMI, HbA1C, total cholesterol (TC), LDL-C, HDL-C and triglycerides (TG) were monitored.

RESULTS

Mean BMI increases were higher in the olanzapine group as compared to risperidone (1.3 kg/m(2)(SD = 0.13) vs. 0.7 kg/m(2) (SD = 0.13)(p < 0.001). Increases in mean TC (13.5 mg/dl (SD 2.4), LDL-C (11.0 mg/dl (SD 2.2)) and TG (14.8 mg/dl (SD = 7.6)) occurred in the olanzapine group while significant changes in TC (-3.9 mg/dl (SD = 2.5)) and TG (-32.8 mg/dl (SD = 7.8)) were noted in the risperidone group. Men (not women) on olanzapine had higher than expected increases in lipids given the amount of weight gain. Baseline values and prior therapy did not contribute to the significant differences, however BMI increases (p = 0.0002) were linked to study discontinuation in both drug groups.

CONCLUSIONS

The fact that significant metabolic changes occurred (both positive and negative) in eight weeks is important to clinical care. Monitoring for metabolic changes may be important within the first eight weeks of treatment, as changes can be determined very early in antipsychotic treatment.

Authors+Show Affiliations

Maryland Psychiatric Research Center, University of Maryland, School of Medicine, Baltimore, Maryland 21228, USA. dkelly@mprc.umaryland.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18568578

Citation

Kelly, Deanna L., et al. "Metabolic Risk With Second-generation Antipsychotic Treatment: a Double-blind Randomized 8-week Trial of Risperidone and Olanzapine." Annals of Clinical Psychiatry : Official Journal of the American Academy of Clinical Psychiatrists, vol. 20, no. 2, 2008, pp. 71-8.
Kelly DL, Conley RR, Love RC, et al. Metabolic risk with second-generation antipsychotic treatment: a double-blind randomized 8-week trial of risperidone and olanzapine. Ann Clin Psychiatry. 2008;20(2):71-8.
Kelly, D. L., Conley, R. R., Love, R. C., Morrison, J. A., & McMahon, R. P. (2008). Metabolic risk with second-generation antipsychotic treatment: a double-blind randomized 8-week trial of risperidone and olanzapine. Annals of Clinical Psychiatry : Official Journal of the American Academy of Clinical Psychiatrists, 20(2), 71-8. https://doi.org/10.1080/10401230802017050
Kelly DL, et al. Metabolic Risk With Second-generation Antipsychotic Treatment: a Double-blind Randomized 8-week Trial of Risperidone and Olanzapine. Ann Clin Psychiatry. 2008 Apr-Jun;20(2):71-8. PubMed PMID: 18568578.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Metabolic risk with second-generation antipsychotic treatment: a double-blind randomized 8-week trial of risperidone and olanzapine. AU - Kelly,Deanna L, AU - Conley,Robert R, AU - Love,Raymond C, AU - Morrison,John A, AU - McMahon,Robert P, PY - 2008/6/24/pubmed PY - 2008/7/8/medline PY - 2008/6/24/entrez SP - 71 EP - 8 JF - Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists JO - Ann Clin Psychiatry VL - 20 IS - 2 N2 - BACKGROUND: The second-generation antipsychotics are effective for treating psychotic disorders and incur fewer motor side effects than are commonly experienced with the use of first-generation antipsychotics. However, their use is commonly associated with weight gain and metabolic disturbances. This study examined weight and metabolic changes with two widely used antipsychotics, risperidone and olanzapine; addressing the issue of early monitoring for metabolic side effects. METHODS: This 8-week double blind randomized trial included patients with schizophrenia or schizoaffective disorder (N = 377) randomly assigned to risperidone (2-6 mg/day) or olanzapine (5-20 mg/day). Weight, BMI, HbA1C, total cholesterol (TC), LDL-C, HDL-C and triglycerides (TG) were monitored. RESULTS: Mean BMI increases were higher in the olanzapine group as compared to risperidone (1.3 kg/m(2)(SD = 0.13) vs. 0.7 kg/m(2) (SD = 0.13)(p < 0.001). Increases in mean TC (13.5 mg/dl (SD 2.4), LDL-C (11.0 mg/dl (SD 2.2)) and TG (14.8 mg/dl (SD = 7.6)) occurred in the olanzapine group while significant changes in TC (-3.9 mg/dl (SD = 2.5)) and TG (-32.8 mg/dl (SD = 7.8)) were noted in the risperidone group. Men (not women) on olanzapine had higher than expected increases in lipids given the amount of weight gain. Baseline values and prior therapy did not contribute to the significant differences, however BMI increases (p = 0.0002) were linked to study discontinuation in both drug groups. CONCLUSIONS: The fact that significant metabolic changes occurred (both positive and negative) in eight weeks is important to clinical care. Monitoring for metabolic changes may be important within the first eight weeks of treatment, as changes can be determined very early in antipsychotic treatment. SN - 1547-3325 UR - https://www.unboundmedicine.com/medline/citation/18568578/Metabolic_risk_with_second_generation_antipsychotic_treatment:_a_double_blind_randomized_8_week_trial_of_risperidone_and_olanzapine_ L2 - https://medlineplus.gov/schizophrenia.html DB - PRIME DP - Unbound Medicine ER -