Effects of switching from olanzapine, quetiapine, and risperidone to aripiprazole on 10-year coronary heart disease risk and metabolic syndrome status

Results from a randomized controlled trial

T. Scott Stroup, Matthew J. Byerly, Henry A. Nasrallah, Neepa Ray, Ahsan Y. Khan, J. Steven Lamberti, Ira D. Glick, Richard M. Steinbook, Joseph P. McEvoy, Robert M. Hamer

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Purpose: This study examined the clinical significance of switching from olanzapine, quetiapine, or risperidone to aripiprazole by examining changes in predicted risk of cardiovascular disease (CVD) according to the Framingham Risk Score (FRS) and metabolic syndrome status. FRS estimates 10-year risk of "hard" coronary heart disease (CHD) outcomes (myocardial infarction and coronary death) while metabolic syndrome is associated with increased risk of CVD, stroke, and diabetes mellitus. Method: Changes in FRS and metabolic syndrome status were compared between patients with BMI ≥ 27 and non-HDL-C ≥ 130 mg/dL randomly assigned to stay on stable current treatment (olanzapine, quetiapine, or risperidone) or switch to treatment with aripiprazole with 24. weeks of follow-up. All study participants were enrolled in a behavioral program that promoted healthy diet and exercise. Results: The pre-specified analyses included 89 switchers and 98 stayers who had post-baseline measurements needed to assess changes. Least squares mean estimates of 10-year CHD risk decreased more for the switch (from 7.0% to 5.2%) than the stay group (from 7.4% to 6.4%) (p = 0.0429). The odds ratio for having metabolic syndrome (stay vs. switch) at the last observation was 1.748 (95% CI 0.919, 3.324, p = 0.0885). Conclusion: Switching from olanzapine, quetiapine, or risperidone to aripiprazole was associated with larger reductions in predicted 10-year risk of CHD than the behavioral program alone. The advantage of switching on metabolic syndrome was not statistically significant. The benefits of switching must be balanced against its risks, which in this study included more discontinuations of the study treatment but no significant increase in symptoms or hospitalizations.

Original languageEnglish (US)
Pages (from-to)190-195
Number of pages6
JournalSchizophrenia Research
Volume146
Issue number1-3
DOIs
StatePublished - May 2013

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olanzapine
Risperidone
Coronary Disease
Randomized Controlled Trials
Cardiovascular Diseases
Myocardial Infarction
Aripiprazole
Quetiapine Fumarate
Least-Squares Analysis

Keywords

  • Antipsychotics
  • Metabolic side effects
  • Randomized clinical trial

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

Cite this

Effects of switching from olanzapine, quetiapine, and risperidone to aripiprazole on 10-year coronary heart disease risk and metabolic syndrome status : Results from a randomized controlled trial. / Stroup, T. Scott; Byerly, Matthew J.; Nasrallah, Henry A.; Ray, Neepa; Khan, Ahsan Y.; Lamberti, J. Steven; Glick, Ira D.; Steinbook, Richard M.; McEvoy, Joseph P.; Hamer, Robert M.

In: Schizophrenia Research, Vol. 146, No. 1-3, 05.2013, p. 190-195.

Research output: Contribution to journalArticle

Stroup, T. Scott ; Byerly, Matthew J. ; Nasrallah, Henry A. ; Ray, Neepa ; Khan, Ahsan Y. ; Lamberti, J. Steven ; Glick, Ira D. ; Steinbook, Richard M. ; McEvoy, Joseph P. ; Hamer, Robert M. / Effects of switching from olanzapine, quetiapine, and risperidone to aripiprazole on 10-year coronary heart disease risk and metabolic syndrome status : Results from a randomized controlled trial. In: Schizophrenia Research. 2013 ; Vol. 146, No. 1-3. pp. 190-195.
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abstract = "Purpose: This study examined the clinical significance of switching from olanzapine, quetiapine, or risperidone to aripiprazole by examining changes in predicted risk of cardiovascular disease (CVD) according to the Framingham Risk Score (FRS) and metabolic syndrome status. FRS estimates 10-year risk of {"}hard{"} coronary heart disease (CHD) outcomes (myocardial infarction and coronary death) while metabolic syndrome is associated with increased risk of CVD, stroke, and diabetes mellitus. Method: Changes in FRS and metabolic syndrome status were compared between patients with BMI ≥ 27 and non-HDL-C ≥ 130 mg/dL randomly assigned to stay on stable current treatment (olanzapine, quetiapine, or risperidone) or switch to treatment with aripiprazole with 24. weeks of follow-up. All study participants were enrolled in a behavioral program that promoted healthy diet and exercise. Results: The pre-specified analyses included 89 switchers and 98 stayers who had post-baseline measurements needed to assess changes. Least squares mean estimates of 10-year CHD risk decreased more for the switch (from 7.0{\%} to 5.2{\%}) than the stay group (from 7.4{\%} to 6.4{\%}) (p = 0.0429). The odds ratio for having metabolic syndrome (stay vs. switch) at the last observation was 1.748 (95{\%} CI 0.919, 3.324, p = 0.0885). Conclusion: Switching from olanzapine, quetiapine, or risperidone to aripiprazole was associated with larger reductions in predicted 10-year risk of CHD than the behavioral program alone. The advantage of switching on metabolic syndrome was not statistically significant. The benefits of switching must be balanced against its risks, which in this study included more discontinuations of the study treatment but no significant increase in symptoms or hospitalizations.",
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T2 - Results from a randomized controlled trial

AU - Stroup, T. Scott

AU - Byerly, Matthew J.

AU - Nasrallah, Henry A.

AU - Ray, Neepa

AU - Khan, Ahsan Y.

AU - Lamberti, J. Steven

AU - Glick, Ira D.

AU - Steinbook, Richard M.

AU - McEvoy, Joseph P.

AU - Hamer, Robert M.

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N2 - Purpose: This study examined the clinical significance of switching from olanzapine, quetiapine, or risperidone to aripiprazole by examining changes in predicted risk of cardiovascular disease (CVD) according to the Framingham Risk Score (FRS) and metabolic syndrome status. FRS estimates 10-year risk of "hard" coronary heart disease (CHD) outcomes (myocardial infarction and coronary death) while metabolic syndrome is associated with increased risk of CVD, stroke, and diabetes mellitus. Method: Changes in FRS and metabolic syndrome status were compared between patients with BMI ≥ 27 and non-HDL-C ≥ 130 mg/dL randomly assigned to stay on stable current treatment (olanzapine, quetiapine, or risperidone) or switch to treatment with aripiprazole with 24. weeks of follow-up. All study participants were enrolled in a behavioral program that promoted healthy diet and exercise. Results: The pre-specified analyses included 89 switchers and 98 stayers who had post-baseline measurements needed to assess changes. Least squares mean estimates of 10-year CHD risk decreased more for the switch (from 7.0% to 5.2%) than the stay group (from 7.4% to 6.4%) (p = 0.0429). The odds ratio for having metabolic syndrome (stay vs. switch) at the last observation was 1.748 (95% CI 0.919, 3.324, p = 0.0885). Conclusion: Switching from olanzapine, quetiapine, or risperidone to aripiprazole was associated with larger reductions in predicted 10-year risk of CHD than the behavioral program alone. The advantage of switching on metabolic syndrome was not statistically significant. The benefits of switching must be balanced against its risks, which in this study included more discontinuations of the study treatment but no significant increase in symptoms or hospitalizations.

AB - Purpose: This study examined the clinical significance of switching from olanzapine, quetiapine, or risperidone to aripiprazole by examining changes in predicted risk of cardiovascular disease (CVD) according to the Framingham Risk Score (FRS) and metabolic syndrome status. FRS estimates 10-year risk of "hard" coronary heart disease (CHD) outcomes (myocardial infarction and coronary death) while metabolic syndrome is associated with increased risk of CVD, stroke, and diabetes mellitus. Method: Changes in FRS and metabolic syndrome status were compared between patients with BMI ≥ 27 and non-HDL-C ≥ 130 mg/dL randomly assigned to stay on stable current treatment (olanzapine, quetiapine, or risperidone) or switch to treatment with aripiprazole with 24. weeks of follow-up. All study participants were enrolled in a behavioral program that promoted healthy diet and exercise. Results: The pre-specified analyses included 89 switchers and 98 stayers who had post-baseline measurements needed to assess changes. Least squares mean estimates of 10-year CHD risk decreased more for the switch (from 7.0% to 5.2%) than the stay group (from 7.4% to 6.4%) (p = 0.0429). The odds ratio for having metabolic syndrome (stay vs. switch) at the last observation was 1.748 (95% CI 0.919, 3.324, p = 0.0885). Conclusion: Switching from olanzapine, quetiapine, or risperidone to aripiprazole was associated with larger reductions in predicted 10-year risk of CHD than the behavioral program alone. The advantage of switching on metabolic syndrome was not statistically significant. The benefits of switching must be balanced against its risks, which in this study included more discontinuations of the study treatment but no significant increase in symptoms or hospitalizations.

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