Objective: To compare longitudinal metabolic effects of 7 antipsychotics, including body mass index (BMI), waist circumference (WC), blood pressure (BP), glucose, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C); to investigate risk factors for metabolic syndrome (MetS); and to make recommendations on frequency and timing of monitoring metabolic measurements.
Methods: This randomized, open-label, pharmacologic trial was conducted among patients with schizophrenia (DSM-IV) in 32 hospitals across China. Patients were randomly assigned to 7 groups and assessed at baseline, 2, 4, and 6 weeks. Linear mixed-effect models were used to assess changes of metabolic measures over time. Multivariable logistic regression analysis was performed to investigate the risk factors for MetS.
Results: In total, 2,550 (718 drug-naׯve) of 2,774 patients finished the study between July 6, 2010, and November 30, 2011. We found significant (P < .05) changes for BMI, WC, TG, and LDL-C, with TG and LDL-C reaching a plateau. Interactions between baseline metabolic condition and changes over time were observed for BMI (χ2 = 43.11, P < .001), WC (χ2 = 36.34, P < .001), systolic BP (χ2 = 11.92, P = .002), glucose (χ2 = 6.09, P = .01), and TG (χ2 = 6.01, P = .01). Antipsychotics generally had greater adverse effects on patients who were initially screened as metabolically normal. After controlling for other associated factors, we found that antipsychotics resulted in differing risk for incident MetS, with a similar pattern to findings in other populations: olanzapine (odds ratio [OR] = 3.36, P < .001) > quetiapine (OR = 3.29, P < .001) > perphenazine (OR = 2.73, P = .007) > risperidone (OR = 2.21, P = .02) > aripiprazole (OR = 1.74, P = .15) ≈ haloperidol (OR = 1.75, P = .22) ≈ ziprasidone (OR = 1, reference).
Conclusions: Metabolic traits should be monitored frequently in early stages of antipsychotic treatment due to rapid and substantial changes. Clinicians should not assume low risk for patients with normal metabolic parameters at baseline.
Trial Registration: Chinese Clinical Trial Registry identifier: ChiCTR-TRC-10000934
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About the Authors
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Liwen Tan, MDSecond Xiangya Hospital, Central South University, Hunan, ChinaView full profile
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Tao Li, MDMental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Corresponding author: Tao Li, MD, #28 Dianxin South St, Chengdu 610041, Sichuan, China ([email protected])View full profile
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Yamin Zhang, PhDMental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, ChinaView full profile
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Qiang Wang, MDMental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, ChinaView full profile
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Gavin P. Reynolds, PhDBiomolecular Science Research Centre, Sheffield Hallam University, Sheffield, United KingdomView full profile
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Weihua Yue, MD, PhDPeking University Sixth Hospital (Institute of Mental Health), Beijing, China; National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, ChinaView full profile
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Wei Deng, MDMental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, ChinaView full profile
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Hao Yan, MDPeking University Sixth Hospital (Institute of Mental Health), Beijing, China; National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, ChinaView full profile
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Chuanyue Wang, MD, PhDBeijing Anding Hospital, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, ChinaView full profile
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Guigang Yang, MDBeijing HuiLongGuan Hospital, Beijing, ChinaView full profile
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Tianlan Lu, MDPeking University Sixth Hospital (Institute of Mental Health), Beijing, China; National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, ChinaView full profile
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Lifang Wang, MDPeking University Sixth Hospital (Institute of Mental Health), Beijing, China; National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, ChinaView full profile
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Fuquan Zhang, MDWuxi Mental Health Center, Nanjing Medical University, Wuxi, Jiangshu, ChinaView full profile
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Jianli Yang, MDInstitute of Mental Health, Tianjin Anding Hospital, Tianjin, China; Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, ChinaView full profile
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Keqing Li, MDHebei Mental Health Center, Baoding, Hebei, ChinaView full profile
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Luxian Lv, MDSecond Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, ChinaView full profile
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Qingrong Tan, MDDepartment of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi' an, Shanxi, ChinaView full profile
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Yinfei Li, MDMental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, ChinaView full profile
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Hua Yu, MDMental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, ChinaView full profile
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Hongyan Zhang, MD, PhDPeking University Sixth Hospital (Institute of Mental Health), Beijing, China; National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, ChinaView full profile
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Xin Ma, MDBeijing Anding Hospital, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, ChinaView full profile
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Fude Yang, MDBeijing HuiLongGuan Hospital, Beijing, ChinaView full profile
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Lingjiang Li, MDSecond Xiangya Hospital, Central South University, Hunan, ChinaView full profile
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Qi Chen, MDBeijing Tiantan Hospital, Capital Medical University, Beijing, ChinaView full profile
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Wei Wei, MDMental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, ChinaView full profile
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Liansheng Zhao, MScMental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, ChinaView full profile
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Huiyao Wang, MMedMental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, ChinaView full profile
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Xiaojing Li, MDMental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, ChinaView full profile
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Wanjun Guo, MDMental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, ChinaView full profile
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Xun Hu, PhDHuaxi Biobank, West China Hospital of Sichuan University, Chengdu, Sichuan, ChinaView full profile
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Yang Tian, MScMental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, ChinaView full profile
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Hongyan Ren, MDMental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, ChinaView full profile
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Xiaohong Ma, MDMental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, ChinaView full profile
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Jeremy Coid, MDMental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, ChinaView full profile
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Dai Zhang, MD, PhDPeking University Sixth Hospital (Institute of Mental Health), Beijing, China; National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, ChinaView full profile
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