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Clinical and Research News
Antipsychotic Lowers Metabolic Risk, but Discontinuation a Concern
Psychiatric News
Volume 46 Number 20 page 16-16

Switching to aripiprazole from antipsychotic medications that carry a greater risk of metabolic side effects may help reduce the likelihood of developing cardiovascular disease, according to a study in the September American Journal of Psychiatry.

The 24-week randomized trial compared the metabolic risk for cardiovascular disease of individuals continuing a clinically stable course of treatment with olanzapine, quetiapine, or risperidone with that of patients switching from one of those antipsychotic medications to aripiprazole.

All of the 215 study participants were identified at baseline as having non-HDL cholesterol levels of more than 130 mg/dl and being overweight according to body mass index measurements—two risk factors for cardiovascular disease. For the duration of the study, participants were enrolled in a "behaviorally oriented" diet-and-exercise program in addition to receiving their medication.

The study's lead author, T. Scott Stroup, M.D., M.P.H., a professor of psychiatry at Columbia University and director of the New York State Psychiatric Institute's Program for Intervention Effectiveness Research, collaborated with nine researchers in assessing changes in participants' non-HDL cholesterol and the efficacy of their course of treatment.

For the first month of the study, patients were evaluated weekly at one of 27 clinical research centers across the country affiliated with the Schizophrenia Trials Network, which is coordinated by the University of North Carolina at Chapel Hill. Laboratory assessments and subsequent clinic visits were conducted every four weeks.

Those patients switching to aripiprazole experienced a mean drop in non-HDL cholesterol levels of 20.2 mg/dl, nearly twice that of participants remaining on their prescribed medication. Additionally, those on aripiprazole lost a mean 3.6 kg of weight, compared with 0.7 kg in the other group.

The researchers noted that 43.9 percent of those in the aripiprazole group stopped taking the drug before the study was completed, compared with 24.5 percent of those in the other group. Of those patients discontinuing treatment with aripiprazole, 20.6 percent did so due to "protocol-specified efficacy failure," compared with 17 percent of those in the non-aripiprazole cohort.

Additionally, 16.8 percent of those in the aripiprazole group experienced such adverse effects as hospitalizations or "medically significant or life-threatening events," compared with 9.4 percent of patients in the other group.

The researchers concluded that switching antipsychotic medications in an effort to reduce the metabolic risk for cardiovascular disease is a "reasonable" option when accompanied by close clinical monitoring.

The study was supported by a grant from the Foundation for the National Institutes of Health (FNIH) and a contract from the National Institute of Mental Health. Bristol-Myers Squibb provided aripiprazole and funds to FNIH in support of the study.

"A Randomized Trial Examining the Effectiveness of Switching From Olanzapine, Quetiapine, or Risperidone to Aripiprazole to Reduce Metabolic Risk: Comparison of Antipsychotics for Metabolic Problems (CAMP)" is posted at <http://ajp.psychiatryonline.org/cgi/reprint/168/9/947>.16_2.inline-graphic-1.gif

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