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Weight Change and Metabolic Effects of Asenapine in Patients With Schizophrenia and Bipolar Disorder

J Clin Psychiatry 2014;75(3):238-245
10.4088/JCP.12m08271

Objective: To describe weight changes and metabolic effects of asenapine compared with placebo and olanzapine in adults.

Method: Post hoc analyses were performed using data from 17 asenapine trials (13 schizophrenia and 4 bipolar mania trials) with placebo (5–10 mg twice daily; n = 1,748; 1–6 weeks) and/or olanzapine (5–20 mg, once daily; n = 3,430; 3–100 weeks). Data were pooled based on treatment into placebo-controlled and olanzapine-controlled trials. For trials with placebo and olanzapine treatment groups, the asenapine population was included in both pools. Changes from baseline for weight, body mass index, and fasting lipid and glucose levels were determined. The Medical Dictionary for Regulatory Activities was used to define metabolic adverse events.

Results: Mean (standard error [SE]) weight change was greater with asenapine than with placebo (1.2 [0.2] vs 0.14 [0.2] kg; P < .0001) and similar in schizophrenia and bipolar disorder. Mean changes differed for asenapine versus placebo in triglycerides (1.8 [6.3] vs –12.2 [5.9] mg/dL; P < .01) and fasting glucose (1.9 [1.7] vs –1.6 [1.5] mg/dL; P < .05). In the olanzapine-controlled trials, weight change was significantly lower with asenapine than with olanzapine (0.9 [0.1] vs 3.1 [0.2] kg; P < .0001). Changes associated with asenapine were lower than those with olanzapine in fasting glucose (2.0 vs 3.3 mg/dL), total cholesterol (–0.4 [1.1] vs 6.2 [1.2] mg/dL; P < .0001), low-density lipoprotein cholesterol (–0.3 [1.1] vs 3.1 [1.2] mg/dL; P < .01), and triglycerides (–0.9 [5.4] vs 24.3 [5.8] mg/dL; P < .0001).

Conclusions: Asenapine was associated with greater weight gain and glucose changes than placebo and not associated with a meaningful change in triglycerides or cholesterol levels. Asenapine was not significantly different from olanzapine in change in glucose levels and lower than olanzapine with respect to triglycerides, weight gain, and increased cholesterol.

J Clin Psychiatry

Submitted: November 6, 2012; accepted July 24, 2013.

Online ahead of print: December 24, 2013 (doi:10.4088/JCP.12m08271).

Corresponding author: David E. Kemp, MD, MS, 10524 Euclid Ave, 12th Floor, Cleveland, OH 44106 (kemp.david@gmail.com).