Effects of switching from olanzapine, quetiapine, and risperidone to aripiprazole on 10-year coronary heart disease risk and metabolic syndrome status: Results from a randomized controlled trial

Abstract

Purpose This study examined the clinical significance of switching from olanzapine, quetiapine, or risperidone to aripiprazole by examining changes in predicted risk of cardiovascular disease (CVD) according to the Framingham Risk Score (FRS) and metabolic syndrome status. FRS estimates 10-year risk of “hard” coronary heart disease (CHD) outcomes (myocardial infarction and coronary death) while metabolic syndrome is associated with increased risk of CVD, stroke, and diabetes mellitus. Method Changes in FRS and metabolic syndrome status were compared between patients with BMI ≥ 27 and non-HDL-C ≥ 130 mg/dL randomly assigned to stay on stable current treatment (olanzapine, quetiapine, or risperidone) or switch to treatment with aripiprazole with 24 weeks of follow-up. All study participants were enrolled in a behavioral program that promoted healthy diet and exercise. Results The pre-specified analyses included 89 switchers and 98 stayers who had post-baseline measurements needed to assess changes. Least squares mean estimates of 10-year CHD risk decreased more for the switch (from 7.0% to 5.2%) than the stay group (from 7.4% to 6.4%) (p=0.0429). The odds ratio for having metabolic syndrome (stay vs. switch) at the last observation was 1.748 (95% CI 0.919, 3.324, p=0.0885). Conclusion Switching from olanzapine, quetiapine, or risperidone to aripiprazole was associated with larger reductions in predicted 10-year risk of CHD than the behavioral program alone. The advantage of switching on metabolic syndrome was not statistically significant. The benefits of switching must be balanced against its risks, which in this study included more discontinuations of the study treatment but no significant increase in symptoms or hospitalizations.

Fast Versus Slow Strategy of Switching Patients With Schizophrenia to Aripiprazole From Other Antipsychotics

“…Both groups had a better improvement in metabolic profile except for fasting glucose, consistent with recent trials. 17,19 In light of the growing concern over the prevalence of metabolic syndrome in schizophrenic patients, 44 the improvement in metabolic profile after switching to aripiprazole may help patients maintain therapeutic adherence. Another advantage of switching to aripiprazole is the prominent decrease in prolactin levels.…”

“…10 Common reasons for switching from 1 antipsychotic to another are a lack of response and induced adverse effects, 11 and the switching strategies have received increasing attention in recent years. [12][13][14][15] Recent trials reported that switching to aripiprazole from other antipsychotics was not only effective 16 but also could improve metabolic parameters 17,18 and coronary heart disease risk, 19 although they also noted higher discontinuation rates with aripiprazole. The main issues during the switching period include re-emergence or worsening of psychosis, along with unpleasant adverse effects such as insomnia, nausea, vomiting, anxiety, and agitation.…”

Weight gain and antipsychotics: a drug safety review

“…Stroup et al found an advantage regarding 10-year cardiovascular risk in patients switched to aripiprazole due to metabolic adverse events from olanzapine, quetiapine or risperidone. On the other hand, discontinuation of treatment was higher in the switching group [112]. Thus recommendations are not so easy and are beyond the scope of this review.…”

Use of aripiprazole for delirium in the elderly: a short review

“…All of the study participants were enrolled in a behavioural programme that promoted healthy diet and exercise. Switching from olanzapine, quetiapine, or risperidone to aripiprazole was associated with larger reductions in the predicted 10‐year risk of coronary heart disease than the behavioural programme alone …”