title: A randomized trial examining the effectiveness of switching from olanzapine, quetiapine, or risperidone to aripiprazole to reduce metabolic risk: comparison of antipsychotics for metabolic problems (CAMP).
abstract: OBJECTIVE
  The authors conducted a multisite randomized controlled trial examining the strategy of switching from olanzapine, quetiapine, or risperidone to aripiprazole to ameliorate metabolic risk factors for cardiovascular disease.
  
  
  METHODS
  Patients with schizophrenia or schizoaffective disorder with a body mass index ≥ 27 and non-high-density lipoprotein (non-HDL) cholesterol ≥ 130 mg/dl who were on a stable treatment dosage of olanzapine, quetiapine, or risperidone were randomly assigned to switch to ari-piprazole (N=109) for 24 weeks or stay on their current medication (N=106). All participants were enrolled in a behaviorally oriented diet and exercise program. Clinical raters were blinded to treatment assignment. The primary and key secondary outcomes were change in non-HDL cholesterol and efficacy failure, respectively.
  
  
  RESULTS
  The prespecified primary analysis included 89 switchers and 98 stayers who had at least one postbaseline non-HDL cholesterol measurement. The least squares mean estimates of non-HDL cholesterol decreased more for the switch group than for the stay group (-20.2 mg/dl and -10.8 mg/dl, respectively). Switching was associated with larger weight reductions (least squares mean=2.9 kg) and a net reduction of serum triglycerides of 32.7 mg/dl. Twenty-two switchers (20.6%) and 18 stayers (17.0%) experienced protocol-defined efficacy failure. Forty-seven switchers (43.9%) and 26 stayers (24.5%) discontinued the assigned antipsychotic medication before 24 weeks.
  
  
  CONCLUSIONS
  Switching to aripiprazole led to improvement of non-HDL cholesterol levels and other metabolic parameters. Rates of efficacy failure were similar between groups, but switching to aripiprazole was associated with a higher rate of treatment discontinuation. In the context of close clinical monitoring, switching from an antipsychotic with high metabolic risk to one with lower risk to improve metabolic parameters is an effective strategy.
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, USA. stroups@nyspi.columbia.edu
authors.forename: T Scott
authors.initials: TS
authors.lastname: Stroup
authors.forename: Joseph P
authors.initials: JP
authors.lastname: McEvoy
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Ring
authors.forename: Robert H
authors.initials: RH
authors.lastname: Hamer
authors.forename: Lisa M
authors.initials: LM
authors.lastname: LaVange
authors.forename: Marvin S
authors.initials: MS
authors.lastname: Swartz
authors.forename: Robert A
authors.initials: RA
authors.lastname: Rosenheck
authors.forename: Diana O
authors.initials: DO
authors.lastname: Perkins
authors.forename: Abraham M
authors.initials: AM
authors.lastname: Nussbaum
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Lieberman
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D000068180:Aripiprazole; D001569:Benzodiazepines / Q000009:adverse effects* / Q000627:therapeutic use*; D015992:Body Mass Index; D001835:Body Weight / Q000187:drug effects; D002784:Cholesterol / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003131:Combined Modality Therapy; D003987:Dibenzothiazepines / Q000009:adverse effects* / Q000627:therapeutic use*; D004038:Diet, Reducing; D057915:Drug Substitution; D015444:Exercise; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000139:chemically induced* / Q000517:prevention & control*; D000077152:Olanzapine; D010879:Piperazines / Q000009:adverse effects* / Q000627:therapeutic use*; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D000069348:Quetiapine Fumarate; D015363:Quinolones / Q000009:adverse effects* / Q000627:therapeutic use*; D012306:Risk; D018967:Risperidone / Q000009:adverse effects* / Q000627:therapeutic use*; D012559:Schizophrenia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
chemical_list: D014150:Antipsychotic Agents; D008078:Cholesterol, LDL; D003987:Dibenzothiazepines; D010879:Piperazines; D015363:Quinolones; D014280:Triglycerides; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate; D000068180:Aripiprazole; D002784:Cholesterol; D018967:Risperidone; D000077152:Olanzapine