title: Atypical Antipsychotics and the Risk of Hyperlipidemia: A Sequence Symmetry Analysis.
abstract: BACKGROUND
  Although hyperlipidemia is a well known adverse event of atypical antipsychotic (AAP) medication, there are few studies that have quantitatively compared the risks of various AAPs.
  
  
  OBJECTIVE
  Our aim was to comparatively evaluate the risk of hyperlipidemia associated with the use of AAPs approved in Japan through a consecutive epidemiological study.
  
  
  METHODS
  We conducted a sequence symmetry analysis (SSA) using health insurance claims data to analyze the following nine AAPs approved for use in Japan: risperidone, paliperidone, perospirone hydrochloride hydrate, blonanserin, clozapine, olanzapine, quetiapine fumarate, aripiprazole, and zotepine. Exposed cases were identified from drug dispensing records as those who had been administered both AAPs and antihyperlipidemic drugs. The adjusted sequence ratio (ASR) and 95 % confidence interval (CI) for each individual AAP and for all AAPs were calculated while controlling for time trends in dispensing patterns.
  
  
  RESULTS
  Olanzapine was significantly associated with increased hyperlipidemia occurrence (ASR 1.56; 95 % CI 1.25-1.95). The ASRs obtained for risperidone (1.01; 95 % CI 0.80-1.27), perospirone hydrochloride hydrate (0.93; 95 % CI 0.63-1.39), blonanserin (0.83; 95 % CI 0.52-1.33), quetiapine fumarate (0.93; 95 % CI 0.73-1.18), and aripiprazole (1.02; 95 % CI 0.82-1.26) were approximately 1.0. Unstable estimates (wide CIs) were obtained for paliperidone and zotepine due to the small sample sizes.
  
  
  CONCLUSIONS
  Among the AAPs used in Japan, only olanzapine was found to have an elevated risk of hyperlipidemia. In contrast, risperidone, perospirone hydrochloride hydrate, blonanserin, quetiapine fumarate, and aripiprazole had relatively low risks.
authors.affiliation: Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Shin-kasumigaseki Bldg., 3-3-2, Kasumigaseki, Chiyoda-ku, Tokyo, 100-0013, Japan, takeuchi-yoshinori@pmda.go.jp.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Takeuchi
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kajiyama
authors.forename: Chieko
authors.initials: C
authors.lastname: Ishiguro
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Uyama
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000145:classification; D001569:Benzodiazepines / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D000077152:Olanzapine; D061214:Patient Safety; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines; D000077152:Olanzapine