Predicted Risk of Diabetes and Coronary Heart Disease in Patients With Schizophrenia

Ochsner Clinic Foundation, New Orleans, LA, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 05/2008; 69(5):741-8. DOI: 10.4088/JCP.v69n0507
Source: PubMed


Patients with schizophrenia are at increased risk of developing diabetes mellitus and cardiovascular disease. Furthermore, some atypical antipsychotics are associated with metabolic disturbances, which augment the risk for these comorbid conditions. In clinical trials, effects on metabolic parameters with aripiprazole are similar to those with placebo and superior to those with olanzapine, and the Schizophrenia Trial of Aripiprazole (STAR) demonstrated comparable efficacy of aripiprazole versus standard of care (SoC; physicians' selection of quetiapine, olanzapine, or risperidone).
In this post hoc analysis, data from STAR were used to assess the risks of diabetes and coronary heart disease (CHD) in patients with schizophrenia. The Stern (San Antonio Heart Disease Study) and Framingham models, with modifications, were used to predict the risk of diabetes at 7.5 years and CHD at 10 years, respectively.
Aripiprazole-treated patients had more favorable changes in lipids, glucose, and body weight versus SoC. In a subsample of patients who had fasting lipid and glucose test results, the Stern model predicted 23.4 fewer incidences of new-onset diabetes with aripiprazole versus SoC in a hypothetical 1000-patient cohort. The number needed to treat with aripiprazole to avoid 1 adverse outcome expected with SoC was 43. In the same population, the Framingham model predicted 3.9 fewer CHD events, with a number needed to treat with aripiprazole of 256.
Aripiprazole-treated patients had more favorable changes in metabolic parameters compared with SoC, leading to a reduced risk of diabetes and CHD, based on validated models.

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    • "Treatment of schizophrenia with aripiprazole has been shown to induce fewer side effects compared with treatment using first-generation antipsychotics34 as well as with olanzapine and risperidone with regard to metabolic, prolactin-related, and dystonic side effects or QTc prolongation. 32,35 Conversely, switching treatment to aripiprazole could reduce weight gain under olanzapine or clozapine according to a recent meta-analysis including 784 patients. However, mean weight reduction was modest (−2.55 ± 1.5 kg).36 "
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    ABSTRACT: About one third of patients with schizophrenia respond unsatisfactorily to antipsychotic treatment and are termed "treatment-resistant". Clozapine is still the gold standard in these cases. However, 40%-70% of patients do not improve sufficiently on clozapine either. In the search for more efficacious strategies for treatment-resistant schizophrenia, drugs with different pharmacological profiles seem to raise new hopes, but are they valid? The aim of this review was to evaluate the evidence for aripiprazole as a potential strategy in monotherapy or combination therapy for patients with treatment-resistant schizophrenia. The evidence for aripiprazole monotherapy and for the combination of aripiprazole with psychotropics other than clozapine is scant, and no recommendation can be made on the basis of the currently available data. More effort has been made in describing combinations of aripiprazole and clozapine. Most of the open-label and case studies as well as case reports have shown positive effects of this combination on overall psychopathology and to some extent on negative symptoms. Several reports describe the possibility of dose reduction for clozapine in combination with aripiprazole, a strategy that might help so-called "treatment-intolerant" patients. The findings of four randomized controlled trials with respect to changes in psychopathology seem less conclusive. The most commonly found beneficial effects are better metabolic outcomes and indicators of the possibility of reducing the clozapine dose. However, other side effects, such as akathisia, are repeatedly reported. Further, none of the studies report longer-term outcomes. In the absence of alternatives, polypharmacy is a common strategy in clinical practice. Combining aripiprazole with clozapine in clozapine-resistant or clozapine-intolerant patients seems to be worthy of further investigation from the pharmacological and clinical points of view.
    Full-text · Article · May 2012 · Neuropsychiatric Disease and Treatment
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    ABSTRACT: Patients with schizophrenia experience elevated rates of morbidity and mortality, largely due to an increased incidence of cardiovascular disease and diabetes. There is increasing concern that some atypical antipsychotic therapies are associated with adverse metabolic symptoms, such as weight gain, dyslipidaemia and glucose dysregulation. These metabolic symptoms may further increase the risk of coronary heart disease (CHD) and diabetes in this population and, subsequently, the cost of treating these patients' physical health. The STAR study showed that the metabolic side effects of aripiprazole treatment are less than that experienced by those receiving standard-of-care (SOC). In a follow-up study the projected risks for diabetes or CHD, calculated using the Stern and Framingham models, were lower in the aripiprazole treatment group. Assuming the risk of diabetes onset/CHD events remained linear over 10 years, these risks were used to estimate the difference in direct and indirect cost consequences of diabetes and CHD in schizophrenia patients treated with aripiprazole or SOC over a 10-year period. Diabetes costs were estimated from the UKPDS and UK T(2)ARDIS studies, respectively, and CHD costs were estimated using prevalence data from the Health Survey of England and the published literature. All costs were inflated to 2007 costs using the NHS pay and prices index. The number of avoided diabetes cases (23.4 cases per 1,000 treated patients) in patients treated with aripiprazole compared with SOC was associated with estimated total (direct and indirect) cost savings of 37,261,293 pounds over 10 years for the UK population. Similarly, the number of avoided CHD events (3.7 events per 1,000 treated patients) was associated with estimated total cost savings of 7,506,770 pounds over 10 years. Compared with SOC, aripiprazole treatment may provide reductions in the health and economic burden to schizophrenia patients and health care services in the UK as a result of its favourable metabolic profile.
    No preview · Article · Apr 2009 · European Archives of Psychiatry and Clinical Neuroscience
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    ABSTRACT: BACKGROUND: Schizophrenia often co-occurs with chronic medical illnesses. Beside comorbid somatic illness, somatic symptoms appear as a result of side effects of antipsychotics during treatment of psychotic disorders, which may lead to certain diagnostic problems in deciding regarding the origin of such symptoms (somatic illness vs. side effects). The aim of this article is to review literature regarding comorbidity of psychotic disorders and somatic disorders and to point at possible diagnostic problems in differentiating comorbid somatic illness from side effects of antipsychotics. CONTENT ANALYSIS OF LITERATURE: Literature research included structured searches of Medline and other publications on the subject of comorbidity of psychotic disorders and somatic disorders and possible diagnostic problems in differentiating comorbid somatic illnesses from side effects of antipsychotics. CONCLUSION: Co-occurrence of schizophrenia and somatic illnesses is frequent. Genetic factors, sedentary life style, poor diet, risk behaviors and smoking are some important factors that contribute to such comorbidity. Side effects of antipsychotics may cause diagnostic problems in deciding regarding the origin of such symptoms (somatic illness vs. side effects) during treatment of psychotic disorders. Bearing in mind frequent comorbidity between of psychotic and somatic disorders, early recognition of such comorbidity is important, as well as the selection of antipsychotics. It is important to recognize psychotic symptoms in patients with somatic illnesses, as well as somatic illness in patients primarily treated because of psychotic disorder.
    Full-text · Article · Sep 2009 · Psychiatria Danubina
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