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| |  Metabolic Side Effects, Cardiovascular Risk Differs Among Antipsychotic Treatments for Schizophrenia: Presented at ECNP By Jenny Powers ISTANBUL, Turkey -- September 16, 2009 -- The differences in metabolic side effects and cardiovascular risk resulting from antipsychotics make the initial choice of medication important in controlling long-term effects from treatments used for schizophrenia, researchers said here at the 22nd European College of Neuropsychopharmacology (ECNP) Congress. W. Wolfgang Fleischhacker, MD, Biological Psychiatry Department, Medical University Innsbruck, Innsbruck, Austria, and colleagues analysed data from the European First Episode Schizophrenia Trial (EUFEST) study to determine the effects of several first- and second-generation antipsychotics on cardiovascular risk factors in patients with or without metabolic syndrome (MS) risk. Results of the study were presented on September 14. The open-label trial included 498 patients who were randomised to receive haloperidol (n = 103) or amisulpride (n = 104), olanzapine (n = 105), quetiapine (n = 104), and ziprasidone (n = 82). Determination of MS was made at baseline by the presence of 3 or more specified risk components including abdominal obesity as reflected by waist circumference (WC), low high-density lipoproteins (HDL), high triglycerides, blood pressure, and fasting glucose. The moderating impact of MS comorbidities on treatment outcomes was evaluated using statistical interaction tests. Baseline data identified 19 of 422 subjects (4.5%) with >=3 MS risk components, and 233 (55%) had 1 or more elevated risk factors; 36 patients (8%) displayed abdominal obesity and 18 (24%) had hypertension. Tobacco use was reported by 266 (53%) patients. Data were evaluated at baseline, and every 3 months thereafter up to 12 months. In comparison with patients receiving haloperidol, only patients receiving ziprasidone showed a significantly smaller increase in WC over time (P < 0.05); no difference in WC increase was seen between the other drugs (all P > .05) and haloperidol. The median percent change in triglycerides was: +34% for amisulpride; 11% for quetiapine; 9% for olanzapine; +7% for haloperidol; and -31% for ziprasidone. The median percent change in HDL was -12%, 5%, -9%, 0%, and -3%, respectively. At week 52, tobacco use (per week) was significantly higher in the haloperidol group compared to quetiapine (P < .05) and olanzapine (P < .05). Similar, but not statistically significant, differences were observed for amisulpride (P = .27) and ziprasidone (P = .06). After accounting for treatment effects, in the subgroup having 1 or more elevated metabolic risk components at baseline, the increase in body weight was associated with significantly less global assessment of functioning (GAF) improvement (P = .019). The level of GAF improvement had no significant correlation to weight gain in subgroup without MS risk factors (P = .39; statistical interaction test on differences in correlations between the 2 subgroups P = .046). The authors concluded that baseline metabolic comorbidities might moderate the effects of antipsychotic treatment including weight gain and global wellness of patients. The findings suggest that treatment choices may have long-term impact on other aspects of the overall health of schizophrenic patients. Funding for this study was provided by Pfizer Inc. [Presentation title: EUFEST: The Moderating Impact of Metabolic Co-Morbidities on Treatment Outcomes in First-Episode Schizophrenia. Abstract P.3.c.034]
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