Early monitoring of metabolic traits among patients on antipsychotics may reduce adverse effects

Clinicians should frequently monitor metabolic traits during early stages of antipsychotic treatment because of rapid and substantial changes that can occur, according to results of a randomized, open-label, pharmacologic trial published in Journal of Clinical Psychiatry.

Researchers noted that clinicians should not assume patients with normal metabolic parameters at baseline are at low risk.

“Our findings demonstrate that the trajectory of adverse changes among several important contributors to [metabolic syndrome] is established within 2 [weeks to] 4 weeks, which suggests that most clinical guidelines put insufficient emphasis on ongoing, early-stage monitoring,” Yamin Zhang, PhD, of the Mental Health Center and Psychiatric Laboratory at West China Hospital of Sichuan University, and colleagues wrote. “Guidelines that recommend that frequency of monitoring for [metabolic syndrome] should be dependent on the presence of abnormal metabolic parameters observed at baseline require revision.”

Patients with schizophrenia, particularly those who are treated with drugs, have significantly higher prevalence of metabolic syndrome than both drug-naive and first-episode patients. Zhang and colleagues noted this indicates that antipsychotic medication contributes to risk for metabolic syndrome. Prior retrospective studies demonstrated differing risks for metabolic syndrome liability with the use of various antipsychotics. As secondary prevention, researchers have recommended regular monitoring of metabolic measurements following antipsychotic treatment initiation; however, current guidelines do not clearly specify frequency of metabolic syndrome monitoring.

The researchers aimed to compare longitudinal metabolic effects of seven antipsychotics. These effects included BMI, glucose, blood pressure, triglycerides, waist circumference, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Further, they sought to investigate metabolic syndrome risk factors and to make recommendations on frequency and timing of monitoring metabolic measurements.

Zhang and colleagues analyzed complete data of 2,550 patients with schizophrenia, of whom 718 were drug-naive, among 32 hospitals across China. They randomly assigned patients to seven groups, which they assessed at baseline, 2 weeks, 4 weeks and 6 weeks. They used linear mixed-effect models to assess changes of metabolic measures over time and multivariable logistic regression analysis to investigate metabolic syndrome risk factors.

The researchers reported significant changes for BMI, waist circumference, triglycerides and LDL-C, with LDL-C and triglycerides reaching a plateau. They observed interactions between changes over time and baseline metabolic condition for BMI (P < .001), waist circumference (P < .001), systolic blood pressure, (P = .002), glucose (P = .01) and triglycerides (P = .01). Patients initially screened as metabolically normal generally exhibited greater adverse effects. Further, the researchers found that antipsychotics resulted in differing risk for incident metabolic syndrome after controlling for other associated factors, with a similar pattern to findings among other drugs:

• olanzapine (OR = 3.36; 95% CI, 1.73-6.85);

• quetiapine (OR = 3.29; 95% CI, 1.76-6.49);

• perphenazine (OR = 2.73; 95% CI, 1.31-5.79);

• risperidone (OR = 2.21; 95% CI, 1.16-4.43);

• aripiprazole (OR = 1.74; 95% CI, 0.83-3.74);

• haloperidol (OR = 1.75; 95% CI, (0.37-4.29); and

• ziprasidone (OR = 1; reference

“Because of the dramatic changes that can be observed within a relatively short time among patients who are initially screened as metabolically normal, equivalent care should be given to all patients,” the researchers wrote. – by Joe Gramigna

Disclosures: The authors report no relevant financial disclosures.