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The moderating impact of ethnicity on metabolic outcomes during treatment with olanzapine and aripiprazole in patients with schizophrenia.
J Clin Psychiatry. 2009 Mar; 70(3):318-25.JC

Abstract

OBJECTIVE

Race is strongly associated with risk for metabolic dysfunction, but there is limited prospective data concerning the impact of race on antipsychotic metabolic outcomes among patients with schizophrenia.

METHOD

This study is a post hoc analysis of data from a 26-week, double-blind, randomized trial of aripiprazole (N = 155) and olanzapine (N = 159) conducted from April 2000 through June 2001 in patients aged >or= 18 years with acute schizophrenia according to DSM-IV criteria. The data were analyzed on the basis of racial breakdown: white and black/Hispanic. Between-drug and within-drug outcomes were analyzed separately for each racial cohort across weight, lipid, and glucose parameters.

RESULTS

For white subjects (N = 167), olanzapine significantly worsened all metabolic parameters except high-density lipoprotein (HDL) cholesterol and fasting glucose, and this was significantly different than aripiprazole for every outcome except fasting glucose. In the black/Hispanic cohort (N = 137), olanzapine treatment resulted in adverse metabolic outcomes, and these changes were significantly different from aripiprazole for adiposity, total cholesterol, and non-HDL cholesterol. Aripiprazole decreased the odds of endpoint metabolic syndrome compared with olanzapine for all subjects (OR = 0.33, 95% CI = 0.19 to 0.55), the white cohort (OR = 0.20, 95% CI = 0.10 to 0.41), and black/Hispanic subjects (OR = 0.53, 95% CI = 0.25 to 1.12), but the black/Hispanic result was not statistically significant (p = .096). Within the aripiprazole group, white subjects had significantly lower risk for metabolic syndrome, but there was no significant difference in metabolic syndrome between white and black/Hispanic subjects exposed to olanzapine.

CONCLUSIONS

Race may be an important moderator of metabolic risk during atypical antipsychotic therapy. Olanzapine treatment is associated with greater effects on adiposity and lipids than aripiprazole in both white and black/Hispanic subjects, suggesting that antipsychotic choice and intensive monitoring are important in minimizing metabolic risk, especially in nonwhite patients.

Authors+Show Affiliations

Department of Psychiatry, VA San Diego Healthcare System and University of California, San Diego, CA, USA. jmmeyer@ucsd.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19192469

Citation

Meyer, Jonathan M., et al. "The Moderating Impact of Ethnicity On Metabolic Outcomes During Treatment With Olanzapine and Aripiprazole in Patients With Schizophrenia." The Journal of Clinical Psychiatry, vol. 70, no. 3, 2009, pp. 318-25.
Meyer JM, Rosenblatt LC, Kim E, et al. The moderating impact of ethnicity on metabolic outcomes during treatment with olanzapine and aripiprazole in patients with schizophrenia. J Clin Psychiatry. 2009;70(3):318-25.
Meyer, J. M., Rosenblatt, L. C., Kim, E., Baker, R. A., & Whitehead, R. (2009). The moderating impact of ethnicity on metabolic outcomes during treatment with olanzapine and aripiprazole in patients with schizophrenia. The Journal of Clinical Psychiatry, 70(3), 318-25.
Meyer JM, et al. The Moderating Impact of Ethnicity On Metabolic Outcomes During Treatment With Olanzapine and Aripiprazole in Patients With Schizophrenia. J Clin Psychiatry. 2009;70(3):318-25. PubMed PMID: 19192469.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The moderating impact of ethnicity on metabolic outcomes during treatment with olanzapine and aripiprazole in patients with schizophrenia. AU - Meyer,Jonathan M, AU - Rosenblatt,Lisa C, AU - Kim,Edward, AU - Baker,Ross A, AU - Whitehead,Richard, Y1 - 2008/12/16/ PY - 2008/04/03/received PY - 2008/06/16/accepted PY - 2009/2/5/entrez PY - 2009/2/5/pubmed PY - 2009/4/14/medline SP - 318 EP - 25 JF - The Journal of clinical psychiatry JO - J Clin Psychiatry VL - 70 IS - 3 N2 - OBJECTIVE: Race is strongly associated with risk for metabolic dysfunction, but there is limited prospective data concerning the impact of race on antipsychotic metabolic outcomes among patients with schizophrenia. METHOD: This study is a post hoc analysis of data from a 26-week, double-blind, randomized trial of aripiprazole (N = 155) and olanzapine (N = 159) conducted from April 2000 through June 2001 in patients aged >or= 18 years with acute schizophrenia according to DSM-IV criteria. The data were analyzed on the basis of racial breakdown: white and black/Hispanic. Between-drug and within-drug outcomes were analyzed separately for each racial cohort across weight, lipid, and glucose parameters. RESULTS: For white subjects (N = 167), olanzapine significantly worsened all metabolic parameters except high-density lipoprotein (HDL) cholesterol and fasting glucose, and this was significantly different than aripiprazole for every outcome except fasting glucose. In the black/Hispanic cohort (N = 137), olanzapine treatment resulted in adverse metabolic outcomes, and these changes were significantly different from aripiprazole for adiposity, total cholesterol, and non-HDL cholesterol. Aripiprazole decreased the odds of endpoint metabolic syndrome compared with olanzapine for all subjects (OR = 0.33, 95% CI = 0.19 to 0.55), the white cohort (OR = 0.20, 95% CI = 0.10 to 0.41), and black/Hispanic subjects (OR = 0.53, 95% CI = 0.25 to 1.12), but the black/Hispanic result was not statistically significant (p = .096). Within the aripiprazole group, white subjects had significantly lower risk for metabolic syndrome, but there was no significant difference in metabolic syndrome between white and black/Hispanic subjects exposed to olanzapine. CONCLUSIONS: Race may be an important moderator of metabolic risk during atypical antipsychotic therapy. Olanzapine treatment is associated with greater effects on adiposity and lipids than aripiprazole in both white and black/Hispanic subjects, suggesting that antipsychotic choice and intensive monitoring are important in minimizing metabolic risk, especially in nonwhite patients. SN - 1555-2101 UR - https://www.unboundmedicine.com/medline/citation/19192469/The_moderating_impact_of_ethnicity_on_metabolic_outcomes_during_treatment_with_olanzapine_and_aripiprazole_in_patients_with_schizophrenia_ L2 - http://www.psychiatrist.com/jcp/article/pages/2009/v70n03/v70n0303.aspx DB - PRIME DP - Unbound Medicine ER -