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SATIETY: Use of antipsychotic medications in youth linked to increased weight, metabolic changes
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Children and teenagers who were first-time users of antipsychotic medication experienced significant weight gain and increases in cholesterol and triglycerides with three of four medications evaluated, according to results of the Nonrandomized Second-Generation Antipsychotic Treatment Indications, Effectiveness and Tolerability in Youth (SATIETY) cohort study.
Researchers enrolled 338 patients aged 4 to 19 years from semi-urban, tertiary care, academic inpatient and outpatient clinics in Queens, N.Y. Patients had no longer than one week of previous exposure to antipsychotic medication. Two hundred five patients completed the study: 130 had mood spectrum disorder, 82 had schizophrenia spectrum disorder and 60 had disruptive or aggressive behavior spectrum disorders. Fifteen patients who refused to participate or who were nonadherent were included in a comparison group.
Clinicians prescribed aripiprazole (Abilify, Otsuka) to 41 patients included in the analysis, olanzapine to 45 patients, quetiapine to 36 patients, and risperidone to 135 patients.
After a median 10.8 weeks of treatment, weight increased by 8.5 kg in the olanzapine group, 6.1 kg in the quetiapine group, 5.3 kg in the risperidone group, 4.4 kg in the aripiprazole group and 0.2 kg in the untreated comparison group. The researchers noted that 10% to 36% of patients became overweight or obese within 11 weeks.
The researchers also reported metabolic changes from baseline with all of the medications except for aripiprazole. Mean levels of total cholesterol increased for both olanzapine (P<.001) and quetiapine (P=.046). The researchers also noted increases in non-HDL cholesterol (P<.001 and P=.03) and ratio of triglycerides to HDL (P=.002 and P=.004) for olanzapine and quetiapine. Triglycerides increased for patients receiving risperidone (P=.04), olanzapine (P=.002) and quetiapine (P=.01).
“Our results, together with data from first-episode studies, suggest that guidelines for antipsychotic medication exposure for vulnerable pediatric and adolescent patients naive to antipsychotic medication should consider more frequent cardiometabolic monitoring after the first three months of treatment,” the researchers wrote. “The benefits of second-generation antipsychotic medications must be balanced against their cardiometabolic risks through a careful assessment of the indications for their use, consideration of lower-risk alternatives and proactive adverse effect monitoring and management.”
Correll CU. JAMA. 2009;302: 1765-1773.