Predicted Risk of Diabetes and Coronary Heart Disease in Patients With Schizophrenia: Aripiprazole Versus Standard of Care
J Clin Psychiatry 2008;69(5):741-748
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: Patients with schizophrenia are at increased risk
of developing diabetes mellitus and cardiovascular disease. Furthermore, some
atypical antipsychotics are associated with metabolic disturbances, which
augment the risk for these comorbid conditions. In clinical trials, effects on
metabolic parameters with aripiprazole are similar to those with placebo and
superior to those with olanzapine, and the Schizophrenia Trial of Aripiprazole
(STAR) demonstrated comparable efficacy of aripiprazole versus standard of care
(SoC; physicians' selection of quetiapine, olanzapine, or risperidone).
Method: In this post hoc analysis, data from STAR were used to
assess the risks of diabetes and coronary heart disease (CHD) in patients with
schizophrenia. The Stern (San Antonio Heart Disease Study) and Framingham
models, with modifications, were used to predict the risk of diabetes at 7.5
years and CHD at 10 years, respectively.
Results: Aripiprazole-treated patients had more favorable
changes in lipids, glucose, and body weight versus SoC. In a subsample of
patients who had fasting lipid and glucose test results, the Stern model
predicted 23.4 fewer incidences of new-onset diabetes with aripiprazole versus
SoC in a hypothetical 1000-patient cohort. The number needed to treat with
aripiprazole to avoid 1 adverse outcome expected with SoC was 43. In the same
population, the Framingham model predicted 3.9 fewer CHD events, with a number
needed to treat with aripiprazole of 256.
Conclusion: Aripiprazole-treated patients had more favorable
changes in metabolic parameters compared with SoC, leading to a reduced risk of
diabetes and CHD, based on validated models.
Trial Registration: clinicaltrials.gov Identifier: NCT00237913