To further define the metabolic profiles of second-generation
antipsychotics during the treatment of young patients with early
psychosis, with a view to better inform prescribing clinicians.
METHOD:
Weight, body mass index (BMI),
glucose, and serum
lipids were measured in the 52-week Comparison of Atypicals for First Episode (CAFE) study, in which
olanzapine,
quetiapine, and
risperidone were evaluated, and whose primary outcomes have been reported elsewhere. These metabolic data were analyzed using a mixed random coefficients model for continuous longitudinal measures and a logistic regression model for categorical responses.
RESULTS: Of the 400 patients recruited, 31% were
overweight and 18% were obese at baseline, and 17 (4.3%) patients met criteria for
metabolic syndrome. After 12 and 52 weeks of treatment,
weight gain >or=7% from baseline was reported in 29.2% and 50.0% of
quetiapine-treated patients, 59.8% and 80.0% of
olanzapine-treated patients, and 32.5% and 57.6% of
risperidone-treated patients, respectively.
Weight gain after 12 and 52 weeks of treatment was estimated as [Least Squares Mean (SE)] 15.6 (+/-1.1) and 24.2 (+/-1.9) lb for
olanzapine, 8.6 (+/-1.1) and 14.0 (+/-1.9) lb with
risperidone and 7.9 (+/-1.1) and 12.1 (+/-1.8) lb for
quetiapine respectively. In women, greater
weight gain occurred during
risperidone treatment compared with
quetiapine treatment. By week 52, increases in BMI >or=1 unit occurred with significantly higher frequency in
olanzapine-treated patients compared with
quetiapine- or
risperidone-treated patients. By 52 weeks, treatment-emergent
metabolic syndrome was reported in 51 individuals (13.4% of the total population), of whom 22 were receiving
olanzapine, 18
quetiapine, and 11
risperidone.
Risperidone was associated with the smallest elevations in
triglyceride and total
cholesterol levels.
CONCLUSION: