P02-124 - The Need for Evaluation of Metabolic Parameters During Long Term Treatment with Clozapine

Abstract

Treatment with psychotropic drugs is frequently associated with obesity, dislipidemia, hyperglycaemia and hypertension, resulting in the development of the metabolic syndrome which in turn is an important risk factor for cardiovascular disease and type 2 diabetes mellitus. The atypical antipsychotics clozapine and olanzapine have the most pronounced effect on metabolic .parameters. Over the past years, several studies using the definitions of the so called Third Adult Treatment Panel (ATP-III) of the National Cholesterol Education Program, demonstrated a high prevalence of metabolic syndrome in schizophrenic patients treated with atypical antipsychotics. The present study includes a total of 96 clozapine-treated inpatients. A total of 34 patients had to be excluded because of refusal tot participate (n=23) or not meeting the DSM-IV criteria for psychotic disorders (n=11). Finally, 62 patients (male: 46; female: 16; mean age: 49 ± 14.2 years; mean duration of clozapine treatment: 9.2 years; current dose: 331.5mg daily) were evaluated according to ATP-III criteria. Other parameters that were collected comprised co-medication, smoking status and alcohol use. Metabolic syndrome was found in 60% of the patients and was associated with female gender. No association was found between metabolic syndrome and duration of clozapine treatment. Frequencies of the individual components were 92% for dyslipidemia, 43% for obesity, 36% for hypertension, 18% for impaired fasting glucose and 18% for diabetes mellitus type 2. Metabolic syndrome is highly prevalent among patients with psychotic disorders who are treated with clozapine. Additional factors like unhealthy life stile, inactivity and co-medication, emerge as major treatment targets.

Associations between the number of antipsychotics prescribed and metabolic parameters in Japanese patients with schizophrenia

“…Few studies have assessed the effects of the number of antipsychotics prescribed on metabolic parameters, 27 although several studies have compared metabolic parameters between patients who received antipsychotic monotherapy and those who received polypharmacy. 9 , 10 , 11 , 12 , 13 Our sample size ( n = 19,675) was substantially larger than that of previous studies ( n = 118–543), 9 , 10 , 11 , 12 , 13 which enabled the detection of a small yet statistically significant adverse effect of the number of antipsychotics prescribed on BMI and dBP using both univariate and multivariate analyses. The differences in BMI and dBP among the groups were small, and these parameters were within normal limits for all four groups.…”

“… 8 Although several cross‐sectional studies have examined the associations among antipsychotic polypharmacy and metabolic syndromes and metabolic parameters in patients with schizophrenia, findings are inconsistent, which may be attributed to the small sample sizes ( n = 118–543). 9 , 10 , 11 , 12 , 13 Using univariate analysis, Correll et al 10 found that patients treated with antipsychotic polypharmacy had higher rates of metabolic syndromes than those undergoing antipsychotic monotherapy. However, this result became non‐significant after controlling for relevant variables using multiple regression.…”

Metabolic syndrome and its relation to antipsychotic polypharmacy in schizophrenia, schizoaffective and bipolar disorders

“…Antipsychotic polypharmacy was not a predictive factor for MetS in our study, which is similar to many studies (Misawa et al ., 2011; Steylen et al ., 2012; Aly El-Gabry et al ., 2018) but contrary to others (Heiskanen et al ., 2003; Cerit et al ., 2010). No statistically significant association was found between antipsychotic characteristics (number received, class of antipsychotic and route of administration) with the prevalence of MetS.…”