Long-Term Treatment with Atypical Antipsychotics and the Risk of Weight Gain

Background:Data pertaining to changes in weight during long-term treatment with quetiapine (QTP) have been published previously (1).Methods:Pooled data are presented from 26 short-term clinical studies (up to 12 weeks) of QTP or quetiapine extended-release (QTP XR)-as monotherapy or adjunct therapy-conducted by AstraZeneca up to November 2007. Studies were conducted in adult patients (18-65 years) across a number of psychiatric diagnoses. Variables were analyzed irrespective of fasting status with similar analyses planned in the fasting subset. LSM changes from baseline for the difference between QTP and placebo are presented.Results:Approximately 10000 patients were included in the analyses, 70% of whom were treated with QTP or QTP XR. Across the entire short-term dataset, the difference in LSM change in weight for QTP vs. placebo was 1.07 kg. Corresponding differences in glucose regulation parameters were 1.39 mg/dL for glucose and 0.04% units for HbA1C. the overall difference in total cholesterol was 5.48 mg/dL, with differences in HDL and LDL cholesterol of -0.62 mg/dL and 1.69 mg/dL. the difference in LSM change in triglycerides was 22.62 mg/dL.Discussion:Within the context of balancing potential risks against the acknowledged benefits of atypical antipsychotics, the degree and significance of variations in metabolic parameters is an area of continued interest. This analysis helps clinicians to better understand changes in important metabolic parameters across trials with QTP and QTP XR, and the size and uniqueness of the dataset permits further analyses within this important area.Supported by funding from AstraZeneca Pharmaceuticals LP.

Download Full-text

P.2.e.005 Mood stabilisers and atypical antipsychotics in the long-term treatment of bipolar disorder

European Neuropsychopharmacology ◽

10.1016/s0924-977x(10)70578-2 ◽

2010 ◽

Vol 20 ◽

pp. S404-S405

Author(s):

A.C. Altamura ◽

M. Buoli ◽

R.A. Paoli ◽

D. Primavera

Keyword(s):

Bipolar Disorder ◽

Atypical Antipsychotics ◽

Term Treatment ◽

Long Term Treatment

Download Full-text

1056 – Comparative effectiveness of long-term treatment with atypical antipsychotics in patients with schizophrenia

European Psychiatry ◽

10.1016/s0924-9338(13)76176-5 ◽

2013 ◽

Vol 28 ◽

pp. 1

Author(s):

A. Pikalov ◽

L. Citrome ◽

J. Hsu ◽

P. Werner ◽

J. Cucchiaro ◽

...

Keyword(s):

Comparative Effectiveness ◽

Atypical Antipsychotics ◽

Term Treatment ◽

Long Term Treatment

Download Full-text

Pomaglumetad Methionil (LY2140023 Monohydrate) and Aripiprazole in Patients with Schizophrenia: A Phase 3, Multicenter, Double-Blind Comparison

Schizophrenia Research and Treatment ◽

10.1155/2014/758212 ◽

2014 ◽

Vol 2014 ◽

pp. 1-11 ◽

Cited By ~ 24

Author(s):

David H. Adams ◽

Lu Zhang ◽

Brian A. Millen ◽

Bruce J. Kinon ◽

Juan-Carlos Gomez

Keyword(s):

Weight Gain ◽

Adverse Events ◽

Term Treatment ◽

Phase 3 ◽

Serious Adverse Events ◽

Double Blind ◽

Treatment Groups ◽

Long Term Treatment ◽

Blind Comparison

We tested the hypothesis that long-term treatment with pomaglumetad methionil would demonstrate significantly less weight gain than aripiprazole in patients with schizophrenia. In this 24-week, multicenter, randomized, double-blind, Phase 3 study, 678 schizophrenia patients were randomized to either pomaglumetad methionil (n=516) or aripiprazole (n=162). Treatment groups were also compared on efficacy and various safety measures, including serious adverse events (SAEs), discontinuation due to adverse events (AEs), treatment-emergent adverse events (TEAEs), extrapyramidal symptoms (EPS), and suicide-related thoughts and behaviors. The pomaglumetad methionil group showed significantly greater weight loss at Week 24 (Visit 12) compared with the aripiprazole group (−2.8 ± 0.4 versus 0.4 ± 0.6;P<0.001). However, change in Positive and Negative Syndrome Scale (PANSS) total scores for aripiprazole was significantly greater than for pomaglumetad methionil (−15.58 ± 1.58 versus −12.03 ± 0.99;P=0.045). The incidences of SAEs (8.2% versus 3.1%;P=0.032) and discontinuation due to AEs (16.2% versus 8.7%;P=0.020) were significantly higher for pomaglumetad methionil compared with aripiprazole. No statistically significant differences in the incidence of TEAEs, EPS, or suicidal ideation or behavior were noted between treatment groups. In conclusion, long-term treatment with pomaglumetad methionil resulted in significantly less weight gain than aripiprazole. This trial is registered with ClinicalTrials.govNCT01328093.

Download Full-text

Long term treatment with ACE inhibitor enalapril decreases body weight gain and increases life span in rats

Biochemical Pharmacology ◽

10.1016/j.bcp.2009.06.018 ◽

2009 ◽

Vol 78 (8) ◽

pp. 951-958 ◽

Cited By ~ 68

Author(s):

Edson Lucas Santos ◽

Kely de Picoli Souza ◽

Elton Dias da Silva ◽

Elice Carneiro Batista ◽

Paulo J. Forcina Martins ◽

...

Keyword(s):

Body Weight ◽

Weight Gain ◽

Life Span ◽

Ace Inhibitor ◽

Body Weight Gain ◽

Term Treatment ◽

Long Term Treatment

Download Full-text

C.21.02 Long-term treatment with atypical antipsychotics: establishing a balance between efficacy and tolerability

European Neuropsychopharmacology ◽

10.1016/s0924-977x(07)70979-3 ◽

2007 ◽

Vol 17 ◽

pp. S612

Author(s):

A.H. Heald

Keyword(s):

Atypical Antipsychotics ◽

Term Treatment ◽

Long Term Treatment

Download Full-text

Typical and atypical antipsychotics in bipolar disorder

Acta Neuropsychiatrica ◽

10.1017/s0924270800035559 ◽

2000 ◽

Vol 12 (3) ◽

pp. 115-119 ◽

Cited By ~ 9

Author(s):

R.W. Licht

Keyword(s):

Bipolar Disorder ◽

Atypical Antipsychotics ◽

Treatment Guidelines ◽

Bipolar Depression ◽

Term Treatment ◽

Advantages And Disadvantages ◽

Long Term Treatment ◽

Randomised Controlled ◽

Typical Antipsychotics

ABSTRACTBackground: In clinical practice, typical antipsychotics are widely used in the treatment of bipolar disorder, albeit in treatment guidelines often considered as adjunctive agents only. Recently, focus has shifted towards the use of atypical antipsychotics. This paper reviews the advantages and disadvantages associated with the use of antipsychotics in bipolar disorder.Methods: Randomised controlled trials (RCTs) were selected for review. A few review articles were also cited.Results: Typical antipsychotics, at least some of them, are powerful antimanics, beneficial for severe agitation in particular. However, in the long term treatment, typical antipsychics may precipitate depression. Among the atypical antipsychotics, both risperidone and olanzapine are clearly antimanic alternatives, although olanzapine is the best studied. Clozapine seems to be useful when other treatments fail to work.Conclusions: Antipsychotics are beneficial for some clinical presentations of mania. To minimize side effets, atypical agents should be preferred before typical agents, unless parenteral administration is needed. Despite the lack of RCTs, antipsychotics also seem to be useful as adjunctive agents in the treatment of psychotic bipolar depression. For the long term treatment of bipolar disorder, typical antipsychotics should be used only under certain circumstances. The place of atypical antipsychotics in the long term treatment of bipolar disorder remains to be studied.

Download Full-text