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Meta-Analysis
. 2010 Nov;123(2-3):225-33.
doi: 10.1016/j.schres.2010.07.012. Epub 2010 Aug 7.

Head-to-head comparisons of metabolic side effects of second generation antipsychotics in the treatment of schizophrenia: a systematic review and meta-analysis

Christine Rummel-Kluge  1 , Katja Komossa, Sandra Schwarz, Heike Hunger, Franziska Schmid, Claudia Asenjo Lobos, Werner Kissling, John M Davis, Stefan Leucht
Affiliations
Meta-Analysis

Head-to-head comparisons of metabolic side effects of second generation antipsychotics in the treatment of schizophrenia: a systematic review and meta-analysis

Christine Rummel-Kluge et al. Schizophr Res. 2010 Nov.

Abstract

Objective: The metabolic side effects of second-generation antipsychotics (SGA) are serious and have not been compared head to head in a meta-analysis. We conducted a meta-analysis of studies comparing the metabolic side effects of the following SGAs head-to-head: amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, risperidone, sertindole, ziprasidone, zotepine.

Method: We searched the register of the Cochrane schizophrenia group (last search May 2007), supplemented by MEDLINE and EMBASE (last search January 2009) for randomized, blinded studies comparing the above mentioned SGA in the treatment of schizophrenia or related disorders. At least three reviewers extracted the data independently. The primary outcome was weight change. We also assessed changes of cholesterol and glucose. The results were combined in a meta-analysis.

Results: We included 48 studies with 105 relevant arms. Olanzapine produced more weight gain than all other second-generation antipsychotics except for clozapine where no difference was found. Clozapine produced more weight gain than risperidone, risperidone more than amisulpride, and sertindole more than risperidone. Olanzapine produced more cholesterol increase than aripiprazole, risperidone and ziprasidone. (No differences with amisulpride, clozapine and quetiapine were found). Quetiapine produced more cholesterol increase than risperidone and ziprasidone. Olanzapine produced more increase in glucose than amisulpride, aripiprazole, quetiapine, risperidone and ziprasidone; no difference was found with clozapine.

Conclusions: Some SGAs lead to substantially more metabolic side effects than other SGAs. When choosing an SGA for an individual patient these side effects with their potential cause of secondary diseases must be weighed against efficacy and characteristics of the individual patient.

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Figures

Figure 1
Figure 1
Quality of Reports of Meta-analysis (QUOROM) flow-diagram describing the search process
Figure 2
Figure 2
Weight change The left SGA is the one written vertically on the left side, the right SGA is the one written horizontally on the right side of the graph. N = number of studies, n = number of participants, MD = Mean Difference, CI = 95% confidence intervals.
Figure 3
Figure 3
Cholesterol change The left SGA is the one written vertically on the left side, the right SGA is the one written horizontally on the right side of the graph. N = number of studies, n = number of participants, MD = Mean Difference, CI = 95% confidence intervals.
Figure 4
Figure 4
Glucose change The left SGA is the one written vertically on the left side, the right SGA is the one written horizontally on the right side of the graph. N = number of studies, n = number of participants, MD = Mean Difference, CI = 95% confidence intervals.
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References

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