aripiprazole; diabetes; metabolic side effects; metabolic syndrome; schizophrenia
Résumé :
[en] Metabolic abnormalities occur frequently in patients treated with antipsychotics and are of growing concern to clinicians. This study sought to determine whether antipsychotic-associated metabolic abnormalities identified through intensive monitoring can be reversed by switching to aripiprazole. Recent evidence suggests that aripiprazole may exhibit a favorable metabolic safety profile. The study population is a subset of a large (n > 500) ongoing prospective cohort. Thirty-one consecutive patients with schizophrenia who were started on aripiprazole were included in the study. All patients underwent an extensive metabolic evaluation, including an oral glucose tolerance test, at baseline, at 6 weeks, and at 3 months post switch. Metabolic abnormalities were defined as any of the following: new onset diabetes, impaired fasting glucose, impaired glucose tolerance, metabolic syndrome (MetS) according to various definitions, and dyslipidemia. After 3 months of treatment with aripiprazole (mean daily dose 16.3 mg), there was a significant decrease in body weight, body mass index, and waist circumference. There was a significant reduction in fasting glucose, fasting insulin, insulin resistance index, and serum lipids levels (cholesterol, triglycerides, low-density lipoprotein (LDL), LDL/HDL, Chol/HDL, and non-HDL cholesterol). There was also a significant reduction in prolactin levels. All 7 cases of recent onset diabetes were reversed at 3 months follow-up. The MetS was reversed in 50% of patients at 3 months follow-up. Our results support the reversibility of recent onset diabetes on antipsychotic medication when detected early and followed by a switch to aripiprazole.
Disciplines :
Psychiatrie
Auteur, co-auteur :
De Hert, M.
Hanssens, L.
van Winkel, R.
Wampers, M.
Van Eyck, D.
Scheen, André ; Université de Liège - ULiège > Département des sciences cliniques > Diabétologie, nutrition et maladie métaboliques - Médecine interne générale
Peuskens, J.
Langue du document :
Anglais
Titre :
A case series: Evaluation of the metabolic safety of aripiprazole
Homel P, Casey D, Allison DB. Changes in body mass index for individuals with and without schizophrenia, 1987-1996. Schizophr Res. 2002;55:277-284.
Jin H, Meyer JM, Jeste DV. Phenomenology of and risk factors for new-onset diabetes mellitus and diabetic ketoacidosis associated with atypical antipsychotics: an analysis of 45 published cases. Ann Clin Psychiatry. 2002;14:59-64.
Lean ME, Pajonk FG. Patients on atypical antipsychotic drugs: another high-risk group for type 2 diabetes. Diabetes Care. 2003;26:1597-1605.
Meyer JM, Koro CE. The effects of antipsychotic therapy on serum lipids: a comprehensive review. Schizophr Res. 2004;70:1-17.
Scheen AJ, De Hert M. Drug-induced diabetes mellitus: the exemple of atypical antipsychotics. Rev Med Liege. 2005;60:455-460.
De Hert M, van Winkel R, Van Eyck D, et al. Prevalence of the metabolic syndrome in patients with schizophrenia treated with antipsychotic medication. Schizophr Res. 2006;83:87-93.
De Hert M, Van Eyck D, Hanssens L, et al. Oral glucose tolerance tests in treated patients with schizophrenia. Data to support an adaptation of the proposed guidelines for monitoring of patients on second generation antipsychotics? Eur Psychiatry. 2006;21:224-226.
McEvoy JP, Meyer JM, Goff DC, et al. Prevalence of the metabolic syndrome in patients with schizophrenia: baseline results from the clinical antipsychotic trials of intervention effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophr Res. 2005;80:19-32.
Meyer JM, Nasrallah HA, McEvoy JP, et al. The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial: clinical comparison of subgroups with and without the metabolic syndrome. Schizophr Res. 2005;80:9-18.
Jeste DV, Gladsjo JA, Lindamer LA, Larco P. Medical comorbidity in schizophrenia. Schizophr Bull. 1996;22:413-430.
Enger C, Weatherby L, Reynold R, Glasser D, Walker AM. Serious cardio-vascular events and mortality amongst patients with schizophrenia. J Nerv Ment Dis. 2004;192:19-27.
Osby U, Correia N, Brandt L, Ekborn A, Sparen P. Mortality and causes of death in schizophrenia in Stockholm county Sweden. Schizophr Res. 2000;45:21-28.
Dixon L, Postrado L, Delahanty J, Fischer PJ, Lehman A. The association of medical comorbidity in schizophrenia with poor physical and mental health. J Nerv Ment Dis. 1999;187:496-502.
Lyketsos CG, Dunn G, Kaminsky MJ, Breakey WR. Medical comorbidity in psychiatric inpatients: relation to clinical outcomes and hospital length of stay. Psychosomatics. 2002;43:24-30.
Weiden PJ, Mackell JA, McDonnell DD. Obesity as a risk factor for antipsychotic noncompliance. Schizophr Res. 2004;66:51-57.
American Diabetes Association. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care. 2004;27:596-601.
Chue P. The assessment and management of antipsychotic-associated metabolic disturbances from a psychiatric perspective. Can J Psychiatry. 2004;49:200-207.
De Nayer A, De Hert M, Scheen A, Van Gaal L, Peuskens J. Conference report: Belgian consensus on metabolic problems associated with second-generation antipsychotics. Int J Psychiatry Clin Pract. 2005;9:130-137.
Marder SR, Essock SM, Miller AL, et al. Physical health monitoring of patients with schizophrenia. Am J Psychiatry. 2004;161:1334-1349.
De Hert M, Van Eyck D, De Nayer A. Metabolic abnormalities associated with second generation antipsychotics: fact or fiction? Development of guidelines for screening and monitoring. Int Clin Psychopharmacol. 2006;21(suppl 2):11-15.
Newcomer JW. Second-generation (atypical) antipsychotics and metabolic effects: a comprehensive literature review. CNS Drugs. 2005;19(suppl 1):1-93.
DeLeon A, Patel NC, Crismon ML. Aripiprazole: a comprehensive review of its pharmacology, clinical efficacy, and tolerability. Clin Ther. 2004;26:649-666.
McQuade RD, Stock E, Marcus R, et al. A comparison of weight change during treatment with olanzapine or aripiprazole: results from a randomized, double-blind study. J Clin Psychiatry. 2004;65(suppl 18):47-56.
Brixner DI, Said Q, Corey-Lisle PK, et al. Naturalistic impact of second-generation antipsychotics on weight gain. Ann Pharmacother. 2006;40:626-632.
L'Italien G, Casey D, Ray S, Carson W, Marcus RN. Comparison of metabolic syndrome incidence among schizophrenia patients treated with aripiprazole versus olanzapine or placebo. J Clin Psychiatry. In press.
Olfson M, Marcus SC, Corey-Lisle P, Tuomari V, Hines P, L'Italien G. Hyperlipidemia following treatment with antipsychotic medications. J Clin Psychiatry. In press.
Church CO, Stevens DL, Fugate SE. Diabetic ketoacidosis associated with aripiprazole. Diabet Med. 2005;22:1440-1443.
Lorenzo C, Okoloise M, Williams K, Stren P, Haffner S. The metabolic syndrome as predictor of type 2 diabetes: the San Antonio heart study. Diabetes Care. 2003;26:3153-3159.
Stern MP, Williams K, Haffner SM. Identification of persons at high risk for type 2 diabetes mellitus: do we need the oral glucose tolerance test? Ann Intern Med. 2002;136:575-581.
Thakore JH. Metabolic syndrome and schizophrenia. Br J Psychiatry. 2005;186:455-456.
van Winkel R, De Hert M, Van Eyck D, et al. Screening for diabetes and other metabolic abnormalities in patients with schizophrenia and schizoaffective disorder: evaluation of incidence and screening methods. J Clin Psychiatry. In press.
Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care. 2003;26:3160-3166.
Alberti KGMM, Zimmet P, Shaw J. for the IDF Epidemiology Task Force Consensus Group. The metabolic syndrome - a new worldwide definition. Lancet. 2005;366:1059-1062.
Expert Panel on Detection and Evaluation of Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001;285:2486-2497.
Grundy SM, Brewer HBJr, Cleeman JI, Smith SC, Lenfant C. Definition of metabolic syndrome. Report of the National Heart, Lung, and Blood Institute/American Heart Association Conference on scientific issues related to definition. Circulation. 2004;109:433-438.
International Diabetes Federation. The IDF Consensus Worldwide Definition of the Metabolic Syndrome. Brussels, Belgium: Author; 2005. Available at: http://www.idf.org/home/index.cfm?unode=1120071E-AACE-41D2-9FA0- BAB6E25BA072. Accessed August 1, 2006.
De Hert M, Hanssens L, van Winkel R, Wampers M, Van Eyck D, Scheen A, Peuskens J. Reversibility of antipsychotic treatment related diabetes in patients with schizophrenia [Letter to the Editor]. Diabetes Care. In press.
Scheen AJ. Management of the metabolic syndrome. Minerva Endocrinol. 2004;29:31-45.
Lee BH, Kim YK, Park SH. Using aripiprazole to resolve antipsychotic-induced symptomatic hyperprolactinemia: a pilot study. Prog Neuropsychopharmacol Biol Psychiatry. 2006;30(4): 714-717.
De Hert M, Hanssens L, Van Eyck D, Wampers M, Scheen A, Peuskens J. The metabolic syndrome in schizophrenic patients treated with antipsychotics. In: New Research Abstracts. Toronto, Canada: APA; 2006:141. Abstract.