Impact of antipsychotic treatment on nonfasting triglycerides in the CATIE Schizophrenia Trial phase 1.
BACKGROUND
Recent literature documents a stronger association between nonfasting triglycerides (TG) and cardiovascular risk compared to fasting TG. Given concerns over antipsychotic effects on serum TG, this analysis explored changes in nonfasting TG in phase 1 of the CATIE Schizophrenia Trial.


METHODS
Change in nonfasting TG, adjusted for baseline value, was compared between antipsychotic treatment groups using subjects with nonfasting laboratory assessments at baseline and 3 months.


RESULTS
Among the 246 subjects there were significant treatment differences in 3-month change from baseline (p=0.009). The greatest increases in median and adjusted mean nonfasting TG levels were seen among those randomized to quetiapine (mean+54.7 mg/dl, median+26 mg/dl) and olanzapine (mean+23.4 mg/dl, median+26.5 mg/dl), while ziprasidone was neutral (mean+0.0 mg/dl, median+8 mg/dl), and decreases were seen with risperidone (mean -18.4 mg/dl, median -6.5 mg/dl) and perphenazine (mean -1.3 mg/dl, median -22 mg/dl). Pairwise comparisons indicated a significant between-group difference for perphenazine vs. olanzapine (p=0.002) and a trend for perphenazine vs. quetiapine (p=0.006).


CONCLUSIONS
This analysis provides further evidence for differential antipsychotic metabolic liabilities, and confirms signals for the effects of olanzapine and quetiapine on serum TG seen in earlier CATIE analyses. Future consensus recommendations will clarify the role of nonfasting TG monitoring in routine clinical practice.
Department of Psychiatry, University of California, San Diego, VA San Diego Healthcare System, San Diego, CA 92161, United States. jmmeyer@ucsd.edu
Jonathan M
JM
Meyer
Vicki G
VG
Davis
Joseph P
JP
McEvoy
Donald C
DC
Goff
Henry A
HA
Nasrallah
Sonia M
SM
Davis
Gail L
GL
Daumit
John
J
Hsiao
Marvin S
MS
Swartz
T Scott
TS
Stroup
Jeffrey A
JA
Lieberman
D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000097:blood / Q000139:chemically induced; D003987:Dibenzothiazepines / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077152:Olanzapine; D010546:Perphenazine / Q000009:adverse effects / Q000627:therapeutic use; D010879:Piperazines / Q000009:adverse effects / Q000627:therapeutic use; D000069348:Quetiapine Fumarate; D012307:Risk Factors; D018967:Risperidone / Q000009:adverse effects / Q000627:therapeutic use; D012559:Schizophrenia / Q000097:blood / Q000188:drug therapy*; D013844:Thiazoles / Q000009:adverse effects / Q000627:therapeutic use; D014280:Triglycerides / Q000097:blood*
D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D010879:Piperazines; D013844:Thiazoles; D014280:Triglycerides; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate; C092292:ziprasidone; D010546:Perphenazine; D018967:Risperidone; D000077152:Olanzapine