Switching to aripiprazole or ziprasidone could improve weight and other cardiometabolic outcomes in patients with serious mental illness, according to a systematic review and meta-analysis published online in Schizophrenia Bulletin.
“Obesity and adverse metabolic outcomes in patients with severe mental illness are clinically significant but potentially preventable,” researchers explained in the study objective. “Importantly, the evidence for switching to antipsychotics to reduce cardiometabolic burden is unclear.”
To investigate weight and metabolic changes after switching antipsychotic medications, compared with staying on an antipsychotic, researchers meta-analyzed 59 studies, 40% of which were rated high quality.
Switch-versus-stay meta-analyses, which were only possible for aripiprazole and olanzapine, revealed that aripiprazole significantly decreased weight, by 5.52 kilograms. Switching to aripiprazole also significantly decreased fasting glucose by 3.99 mg/dl and triglycerides by 31.03 mg/dl. Conversely, olanzapine significantly increased weight, by 2.46 kilograms, researchers reported. For both antipsychotics, dropout and psychosis ratings were similar between switch and stay groups.
Before-to-after switch meta-analyses were conducted for aripiprazole, amisulpride, clozapine, lurasidone, olanzapine, paliperidone/risperidone, quetiapine, and ziprasidone. Researchers found aripiprazole was associated with a weight loss of 1.96 kilograms and ziprasidone with a loss of 2.22 kilograms. Olanzapine and clozapine, meanwhile, were associated with weight gain of 2.71 kilograms and 2.80 kilograms, respectively. Switching to amisulpride, paliperidone/risperidone, quetiapine, or lurasidone were not associated with any significant weight or other cardiometabolic changes, according to the study.
“Although switching to a different antipsychotic, notably aripiprazole and ziprasidone, may lead to weight loss, these benefits must be weighed against any potential risks of adverse drug reactions or deterioration in psychotic symptoms,” a Psychiatric News Alert article quoted from the paper. “[S]witching antipsychotics in psychiatrically stable patients may risk relapse and detrimental consequences for at least some patients.”
Siskind D, Gallagher E, Winckel K, et al. Does switching antipsychotics ameliorate weight gain in patients with severe mental illness? A systematic review and meta-analysis. Schizophrenia Bulletin. 2021 February 6;[Epub ahead of print].