title: Comparative effectiveness of switching antipsychotic drug treatment to aripiprazole or ziprasidone for improving metabolic profile and atherogenic dyslipidemia: a 12-month, prospective, open-label study.
abstract: We studied the effects of switching antipsychotic drug-treated patients with schizophrenia or bipolar disorder who evidenced adverse metabolic side effects as indicated by a triglyceride/high-density lipoprotein ratio (TG/HDL) ≥ 3.5 to aripiprazole (ARIP; 5-30 mg/day, n = 24) or ziprasidone (ZIP; 40-160 mg/day, n = 28). Anthropometric and metabolic measures, psychopathology, quality of life and motor adverse effects were assessed over a 52-week period with evaluations at baseline, 6, 12, 26 and 52 weeks. There were statistically significant improvements in body weight, body mass index (BMI), TG, HDL and TG/HDL which did not differ between treatments. However, numerous secondary measures including weight and BMI, and the proportion of patients who lost ≥ 7% or who no longer met criteria for obesity, favored ZIP over ARIP. Decreases in total cholesterol and increases in HDL-cholesterol also favored ZIP. On the other hand, decreases in TG/HDL ratio and reduction in HgbA1c favored ARIP. There were no significant time or group × time interaction effects for most psychopathology measures; however, Global Assessment of Functioning Scores favored ARIP at 6 and 12 months. We conclude that switching patients with evidence of metabolic side effects to either ARIP or ZIP may be beneficial for some, but not all metabolic measures, with minimal risk of worsening of psychopathology and possibly some benefit in that regard as well.
authors.affiliation: Department of Psychiatry, University of Arizona School of Medicine, Tuscon, AZ, USA.
authors.forename: Yuejin
authors.initials: Y
authors.lastname: Chen
authors.forename: William V
authors.initials: WV
authors.lastname: Bobo
authors.forename: Kara
authors.initials: K
authors.lastname: Watts
authors.forename: Karuna
authors.initials: K
authors.lastname: Jayathilake
authors.forename: Tinlai
authors.initials: T
authors.lastname: Tang
authors.forename: Herbert Y
authors.initials: HY
authors.lastname: Meltzer
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000068180:Aripiprazole; D050197:Atherosclerosis / Q000453:epidemiology / Q000517:prevention & control; D001714:Bipolar Disorder / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D015331:Cohort Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D016903:Drug Monitoring; D050171:Dyslipidemias / Q000139:chemically induced / Q000150:complications / Q000517:prevention & control*; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D010352:Patient Dropouts; D010879:Piperazines / Q000009:adverse effects / Q000627:therapeutic use*; D011618:Psychotic Disorders / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D015363:Quinolones / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D012559:Schizophrenia / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D012720:Severity of Illness Index; D013844:Thiazoles / Q000009:adverse effects / Q000627:therapeutic use*; D015431:Weight Loss / Q000187:drug effects
chemical_list: D014150:Antipsychotic Agents; D010879:Piperazines; D015363:Quinolones; D013844:Thiazoles; C092292:ziprasidone; D000068180:Aripiprazole