Change in metabolic syndrome parameters with antipsychotic treatment in the CATIE Schizophrenia Trial: Prospective data from phase 1
Change in metabolic syndrome parameters with antipsychotic treatment in the CATIE Schizophrenia Trial: Prospective data from phase 1
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DOI：
10.1016/j.schres.2007.12.487
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发表时间：
2008-04-01
影响因子：
4.5
通讯作者：
Lieberman, Jeffrey A.
中科院分区：
文献类型：
--
作者：
Meyer, Jonathan M.;Davis, Vicki G.;Lieberman, Jeffrey A.
背景：代谢综合征（MS）与糖尿病和冠心病的风险增加有关，在精神分裂症患者中非常普遍。鉴于对抗精神病代谢作用的关注，本分析探讨了CATIE精神分裂症试验I期的MS状态和结果。方法：比较不同抗精神病药物治疗组MS患者比例和个体标准的变化，以及个体标准的平均变化。初步分析在基线和3个月时对受试者进行空腹实验室评估。其他分析检查了所有受试者3个月的MS状态、腰围（WC）、高密度脂蛋白胆固醇和血压的变化，I期参与结束时的代谢变化（EOP），并重复测量HDL、血压（BP）和WC在I期的变化。结果：在3个月时，在较小的禁食队列中（n = 281）符合MS状态或个体MS标准的受试者比例的变化，以及在所有受试者中（n = 660）符合不依赖于禁食状态的参数（BP、HDL、WC）标准的受试者比例的变化，没有显著的药物间差异。在3个月时可以确定多发性硬化状态的所有受试者中（n = 660），奥氮平组的多发性硬化患病率上升（从34.8%上升到43.9%），齐拉西酮组的多发性硬化患病率下降（从37.7%下降到29.9%）（p = .001）。虽然不同亚组的效应大小不同，但在3个月时，奥氮平和喹硫平的腰围平均增幅最大（0.7英寸）。两者都是)，其次是利培酮（0.4英寸），而齐拉西酮（0.0英寸）没有变化，而正非那嗪（-0.4英寸）的腰围减少。与齐拉西酮（-32.1 mg/dl）相比，奥氮平在3个月时空腹甘油三酯的变化（+21.5 mg/dl）也有显著差异。所有代谢变量的EOP暴露数据平均在基线后9个月获得。EOP和重复测量分析的结果与3个月时WC和空腹甘油三酯的平均变化一致，但HDL和收缩压在组间存在差异。结论：这项大型的非工业赞助的研究证实了抗精神病药物对代谢的不同影响。建议临床医生在抗精神病药物治疗期间监测所有代谢参数，包括WC、HDL和血清甘油三酯。(C) 2008 Elsevier B.V.版权所有
Background: The metabolic syndrome (MS) is associated with increased risk for diabetes mellitus and coronary heart disease, and is highly prevalent among schizophrenia patients. Given concerns over antipsychotic metabolic effects, this analysis explored MS status and outcomes in phase I of the CATIE Schizophrenia Trial.Methods: The change in proportion of subjects with MS and individual criteria was compared between antipsychotic treatment groups, along with mean changes for individual criteria. Primary analyses examined subjects with fasting laboratory assessments at baseline and 3 months. Other analyses examined 3-month changes in MS status, waist circumference (WC), HDL cholesterol and blood pressure in all subjects, metabolic changes at the end of phase I participation (EOP), and repeated measures changes in HDL, blood pressure (BP) and WC over phase 1.Results: At 3 months, there were no significant between-drug differences for the change in proportion of subjects meeting MS status or individual MS criteria in the smaller fasting cohort (n = 281) or for those meeting criteria for parameters not dependent on fasting status (BP, HDL, WC) among all subjects (n = 660). Among all subjects whose MS status could be determined at 3 months (n = 660), MS prevalence increased for olanzapine (from 34.8% to 43.9%), but decreased for ziprasidone (from 37.7% to 29.9%) (p = .001). Although effect sizes varied across subgroups, at 3 months olanzapine and quetiapine had the largest mean increase in waist circumference (0.7 in. for both) followed by risperidone (0.4 in.), compared to no change for ziprasidone (0.0 in.) and a decrease in waist circumference for perphenazine (-0.4 in.). Olanzapine also demonstrated significantly different changes in fasting triglycerides at 3 months (+21.5 mg/dl) compared to ziprasidone (-32.1 mg/dl). EOP exposure data was obtained, on average, nine months from baseline for all metabolic variables. Results from EOP and repeated measures analyses were consistent with those at 3 months for mean changes in WC and fasting triglycerides, but between group differences emerged for HDL and SBP.Conclusions: This large non-industry sponsored study confirms the differential metabolic effects between antipsychotics. Clinicians are advised to monitor all metabolic parameters, including WC, HDL and serum triglycerides, during antipsychotic treatment. (C) 2008 Elsevier B.V. All rights reserved.