Head-to-head comparisons of metabolic side effects of second generation antipsychotics in the treatment of schizophrenia: a systematic review and meta-analysis.
OBJECTIVE
The metabolic side effects of second-generation antipsychotics (SGA) are serious and have not been compared head to head in a meta-analysis. We conducted a meta-analysis of studies comparing the metabolic side effects of the following SGAs head-to-head: amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, risperidone, sertindole, ziprasidone, zotepine.


METHODS
We searched the register of the Cochrane schizophrenia group (last search May 2007), supplemented by MEDLINE and EMBASE (last search January 2009) for randomized, blinded studies comparing the above mentioned SGA in the treatment of schizophrenia or related disorders. At least three reviewers extracted the data independently. The primary outcome was weight change. We also assessed changes of cholesterol and glucose. The results were combined in a meta-analysis.


RESULTS
We included 48 studies with 105 relevant arms. Olanzapine produced more weight gain than all other second-generation antipsychotics except for clozapine where no difference was found. Clozapine produced more weight gain than risperidone, risperidone more than amisulpride, and sertindole more than risperidone. Olanzapine produced more cholesterol increase than aripiprazole, risperidone and ziprasidone. (No differences with amisulpride, clozapine and quetiapine were found). Quetiapine produced more cholesterol increase than risperidone and ziprasidone. Olanzapine produced more increase in glucose than amisulpride, aripiprazole, quetiapine, risperidone and ziprasidone; no difference was found with clozapine.


CONCLUSIONS
Some SGAs lead to substantially more metabolic side effects than other SGAs. When choosing an SGA for an individual patient these side effects with their potential cause of secondary diseases must be weighed against efficacy and characteristics of the individual patient.
Rummel-Kluge
Christine
C
Klinik und Poliklinik für Psychiatrie und Psychotherapie der Technischen Universität München, Klinikum rechts der Isar, Möhlstr. 26, 81675 München, Germany. christine.rummel@lrz.tum.de
Komossa
Katja
K
Schwarz
Sandra
S
Hunger
Heike
H
Schmid
Franziska
F
Lobos
Claudia Asenjo
CA
Kissling
Werner
W
Davis
John M
JM
Leucht
Stefan
S
D000077582:Amisulpride; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000068180:Aripiprazole; D001569:Benzodiazepines / Q000009:adverse effects; D001786:Blood Glucose / Q000187:drug effects*; D002784:Cholesterol / Q000097:blood*; D002986:Clinical Trials as Topic; D003024:Clozapine / Q000009:adverse effects; D003987:Dibenzothiazepines / Q000009:adverse effects; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects; D007211:Indoles / Q000009:adverse effects; D000077152:Olanzapine; D010879:Piperazines / Q000009:adverse effects; D000069348:Quetiapine Fumarate; D015363:Quinolones / Q000009:adverse effects; D018967:Risperidone / Q000009:adverse effects; D012559:Schizophrenia / Q000188:drug therapy*; D013469:Sulpiride / Q000009:adverse effects / Q000031:analogs & derivatives; D013844:Thiazoles / Q000009:adverse effects; D015430:Weight Gain / Q000187:drug effects*
D014150:Antipsychotic Agents; D001786:Blood Glucose; D003987:Dibenzothiazepines; D007093:Imidazoles; D007211:Indoles; D010879:Piperazines; D015363:Quinolones; D013844:Thiazoles; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate; C092292:ziprasidone; D013469:Sulpiride; D000077582:Amisulpride; D000068180:Aripiprazole; D002784:Cholesterol; C066304:sertindole; D003024:Clozapine; D018967:Risperidone; D000077152:Olanzapine