Second-Generation Antipsychotic Drugs for Patients with Schizophrenia: Systematic Literature Review and Meta-analysis of Metabolic and Cardiovascular Side Effects

doi:10.1007/s40261-021-01000-1

Meta-Analysis

. 2021 Apr;41(4):303-319.

doi: 10.1007/s40261-021-01000-1. Epub 2021 Mar 9.

Second-Generation Antipsychotic Drugs for Patients with Schizophrenia: Systematic Literature Review and Meta-analysis of Metabolic and Cardiovascular Side Effects

Carla Rognoni¹, Arianna Bertolani², Claudio Jommi²

Affiliations

¹ Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Via Roentgen 1, 20136, Milan, Italy. carla.rognoni@unibocconi.it.
² Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Via Roentgen 1, 20136, Milan, Italy.

PMID: 33686614
PMCID: PMC8004512
DOI: 10.1007/s40261-021-01000-1

Meta-Analysis

Second-Generation Antipsychotic Drugs for Patients with Schizophrenia: Systematic Literature Review and Meta-analysis of Metabolic and Cardiovascular Side Effects

Carla Rognoni et al. Clin Drug Investig. 2021 Apr.

. 2021 Apr;41(4):303-319.

doi: 10.1007/s40261-021-01000-1. Epub 2021 Mar 9.

Authors

Carla Rognoni¹, Arianna Bertolani², Claudio Jommi²

Affiliations

¹ Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Via Roentgen 1, 20136, Milan, Italy. carla.rognoni@unibocconi.it.
² Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Via Roentgen 1, 20136, Milan, Italy.

PMID: 33686614
PMCID: PMC8004512
DOI: 10.1007/s40261-021-01000-1

Abstract

Background and objectives: Second-generation antipsychotics (SGAs) for schizophrenia show different risk profiles, whose evidence has been evaluated through comparative reviews on randomized controlled trials (RCTs) and observational studies.

Methods: We performed a systematic review and meta-analysis of weight gains, metabolic and cardiovascular side effects of SGAs, relying on both RCTs and observational studies, by comparing variations between the start of treatment and the end of follow-up. The systematic review refers to papers published from June 2009 to November 2020. PRISMA criteria were followed. No restrictions on heterogeneity level have been considered for meta-analysis. A test for the summary effect measure and heterogeneity (I² metric) was used.

Results: Seventy-nine papers were selected from 3076 studies (61% RCTs, 39% observational studies). Olanzapine and risperidone reported the greatest weight gain and olanzapine the largest BMI increase. Paliperidone showed the highest increase in total cholesterol, but is the only drug reporting an increase in the HDL cholesterol. Quetiapine XR showed the highest decrease in fasting glucose. Lurasidone showed the lowest increase in body weight and a reduction in BMI and was also the only treatment reporting a decrease in total cholesterol and triglycerides. The highest increase in systolic and diastolic blood pressure was reported by quetiapine XR.

Conclusions: Despite some limitations (differences in the mean dosages per patient and other side effects not included) this paper provides the first complete meta-analysis on SGAs in variations on metabolic risk profile between start of treatment and end of follow-up, with useful results for clinical practice and possibly for future economic evaluation studies.

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Conflict of interest statement

The authors do not declare any conflict of interest.

Figures

**Fig. 1**
Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow chart

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References

1. DSM-5 [Internet]. [cited 2020 Apr 25]. https://www.psychiatry.org/psychiatrists/practice/dsm. Accessed 1 Jan 2021.
1. Matei VP, Mihailescu A, Paraschiv G, Al-Bataineh R, Purnichi T. Weight gain and antipsychotics. Data from eufest study. Acta Endocrinol Buchar Rom 2005. 2016;12:177–84. - PMC - PubMed
1. Mauri MC, Paletta S, Maffini M, Colasanti A, Dragogna F, Di Pace C, et al. Clinical pharmacology of atypical antipsychotics: an update. EXCLI J. 2014;13:1163–1191. - PMC - PubMed
1. Jones PB, Barnes TRE, Davies L, Dunn G, Lloyd H, Hayhurst KP, et al. Randomized controlled trial of the effect on Quality of Life of second- vs first-generation antipsychotic drugs in schizophrenia: Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS 1) Arch Gen Psychiatry. 2006;63:1079–1087. - PubMed
1. Leucht S, Leucht C, Huhn M, Chaimani A, Mavridis D, Helfer B, et al. Sixty years of placebo-controlled antipsychotic drug trials in acute schizophrenia: systematic review, bayesian meta-analysis, and meta-regression of efficacy predictors. Am J Psychiatry. 2017;174:927–942. - PubMed

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[1] DSM-5 [Internet]. [cited 2020 Apr 25]. https://www.psychiatry.org/psychiatrists/practice/dsm. Accessed 1 Jan 2021.

[2] DSM-5 [Internet]. [cited 2020 Apr 25]. https://www.psychiatry.org/psychiatrists/practice/dsm. Accessed 1 Jan 2021.

[3] Matei VP, Mihailescu A, Paraschiv G, Al-Bataineh R, Purnichi T. Weight gain and antipsychotics. Data from eufest study. Acta Endocrinol Buchar Rom 2005. 2016;12:177–84. - PMC - PubMed

[4] Matei VP, Mihailescu A, Paraschiv G, Al-Bataineh R, Purnichi T. Weight gain and antipsychotics. Data from eufest study. Acta Endocrinol Buchar Rom 2005. 2016;12:177–84. - PMC - PubMed

[5] Mauri MC, Paletta S, Maffini M, Colasanti A, Dragogna F, Di Pace C, et al. Clinical pharmacology of atypical antipsychotics: an update. EXCLI J. 2014;13:1163–1191. - PMC - PubMed

[6] Mauri MC, Paletta S, Maffini M, Colasanti A, Dragogna F, Di Pace C, et al. Clinical pharmacology of atypical antipsychotics: an update. EXCLI J. 2014;13:1163–1191. - PMC - PubMed

[7] Jones PB, Barnes TRE, Davies L, Dunn G, Lloyd H, Hayhurst KP, et al. Randomized controlled trial of the effect on Quality of Life of second- vs first-generation antipsychotic drugs in schizophrenia: Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS 1) Arch Gen Psychiatry. 2006;63:1079–1087. - PubMed

[8] Jones PB, Barnes TRE, Davies L, Dunn G, Lloyd H, Hayhurst KP, et al. Randomized controlled trial of the effect on Quality of Life of second- vs first-generation antipsychotic drugs in schizophrenia: Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS 1) Arch Gen Psychiatry. 2006;63:1079–1087. - PubMed

[9] Leucht S, Leucht C, Huhn M, Chaimani A, Mavridis D, Helfer B, et al. Sixty years of placebo-controlled antipsychotic drug trials in acute schizophrenia: systematic review, bayesian meta-analysis, and meta-regression of efficacy predictors. Am J Psychiatry. 2017;174:927–942. - PubMed

[10] Leucht S, Leucht C, Huhn M, Chaimani A, Mavridis D, Helfer B, et al. Sixty years of placebo-controlled antipsychotic drug trials in acute schizophrenia: systematic review, bayesian meta-analysis, and meta-regression of efficacy predictors. Am J Psychiatry. 2017;174:927–942. - PubMed

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Second-Generation Antipsychotic Drugs for Patients with Schizophrenia: Systematic Literature Review and Meta-analysis of Metabolic and Cardiovascular Side Effects

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Second-Generation Antipsychotic Drugs for Patients with Schizophrenia: Systematic Literature Review and Meta-analysis of Metabolic and Cardiovascular Side Effects

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