Comparative effectiveness of switching antipsychotic drug treatment to aripiprazole or ziprasidone for improving metabolic profile and atherogenic dyslipidemia: a 12-month, prospective, open-label study

Abstract

We studied the effects of switching antipsychotic drug-treated patients with schizophrenia or bipolar disorder who evidenced adverse metabolic side effects as indicated by a triglyceride/high-density lipoprotein ratio (TG/HDL) ≥ 3.5 to aripiprazole (ARIP; 5-30 mg/day, n = 24) or ziprasidone (ZIP; 40-160 mg/day, n = 28). Anthropometric and metabolic measures, psychopathology, quality of life and motor adverse effects were assessed over a 52-week period with evaluations at baseline, 6, 12, 26 and 52 weeks. There were statistically significant improvements in body weight, body mass index (BMI), TG, HDL and TG/HDL which did not differ between treatments. However, numerous secondary measures including weight and BMI, and the proportion of patients who lost ≥ 7% or who no longer met criteria for obesity, favored ZIP over ARIP. Decreases in total cholesterol and increases in HDL-cholesterol also favored ZIP. On the other hand, decreases in TG/HDL ratio and reduction in HgbA1c favored ARIP. There were no significant time or group × time interaction effects for most psychopathology measures; however, Global Assessment of Functioning Scores favored ARIP at 6 and 12 months. We conclude that switching patients with evidence of metabolic side effects to either ARIP or ZIP may be beneficial for some, but not all metabolic measures, with minimal risk of worsening of psychopathology and possibly some benefit in that regard as well.

The effect of ziprasidone on metabolic syndrome risk factors in subjects with schizophrenia: a 1 year, open-label, prospective study

“…Certain atypical antipsychotics such as olanzapine and clozapine are strongly associated with adverse metabolic changes, including weight gain, hyperglycemia, and dyslipidemia [18][19][20][21][22] , while other atypical antipsychotics such as aripiprazole and ziprasidone have been shown to have a lower liability for metabolic disruption 23,24 .…”

“…Studies have consistently shown that switching from other atypical antipsychotics to ziprasidone is associated with long-term weight loss and improvement of metabolic indices 23,25,26 ; however, there have been no studies of the impact of ziprasidone on the distribution and prevalence of risk factors for MetS in subjects with schizophrenia or related psychotic disorders. This represents the first prospective and long-term (1 year) study of the effect of an atypical antipsychotic on MetS risk factors among this population.…”

An assessor-blinded, randomized comparison of efficacy and tolerability of switching from olanzapine to ziprasidone and the combination of both in schizophrenia spectrum disorders

“…In those studies, the participants recruited were those who failed to achieve satisfactory response, had poor tolerability for metabolic side effects, or whose conditions had been stable under previous antipsychotic treatment (Alptekin et al, 2009;Chen et al, 2012;Harvey et al, 2004;Lee et al, 2013;Rossi et al, 2008;Simpson et al, 2008;. In contrast, the participants in the present study had not used antipsychotic medications for at least 3 months and the majority of them were firstepisode subjects.…”

“…4 of 25 effects of treatment (Alptekin et al, 2009;Chen et al, 2012;Harvey et al, 2004;Lee et al, 2013;Rossi et al, 2008;Simpson et al, 2008;Weiden et al, 2003a,b). In contrast, there has been only one pilot trial of a combination therapy of ZIP and OLZ, and this did not find additional benefits of ZIP as an adjuvant in chronic schizophrenia (Henderson et al, 2009).…”

“…Only limited data are available on the efficacy and tolerability of long-term treatment following switch to ZIP (Chen et al, 2012;Simpson et al, 2008), therefore the use of a combination of low-dose OLZ and ZIP for long-term maintenance treatment of schizophrenia deserves further investigation.…”