A randomized trial examining the effectiveness of switching from olanzapine, quetiapine, or risperidone to aripiprazole to reduce metabolic risk: comparison of antipsychotics for metabolic problems (CAMP)

Abstract

Objective: The authors conducted a multisite randomized controlled trial examining the strategy of switching from olanzapine, quetiapine, or risperidone to aripiprazole to ameliorate metabolic risk factors for cardiovascular disease.

Method: Patients with schizophrenia or schizoaffective disorder with a body mass index ≥ 27 and non-high-density lipoprotein (non-HDL) cholesterol ≥ 130 mg/dl who were on a stable treatment dosage of olanzapine, quetiapine, or risperidone were randomly assigned to switch to ari-piprazole (N=109) for 24 weeks or stay on their current medication (N=106). All participants were enrolled in a behaviorally oriented diet and exercise program. Clinical raters were blinded to treatment assignment. The primary and key secondary outcomes were change in non-HDL cholesterol and efficacy failure, respectively.

Results: The prespecified primary analysis included 89 switchers and 98 stayers who had at least one postbaseline non-HDL cholesterol measurement. The least squares mean estimates of non-HDL cholesterol decreased more for the switch group than for the stay group (-20.2 mg/dl and -10.8 mg/dl, respectively). Switching was associated with larger weight reductions (least squares mean=2.9 kg) and a net reduction of serum triglycerides of 32.7 mg/dl. Twenty-two switchers (20.6%) and 18 stayers (17.0%) experienced protocol-defined efficacy failure. Forty-seven switchers (43.9%) and 26 stayers (24.5%) discontinued the assigned antipsychotic medication before 24 weeks.

Conclusions: Switching to aripiprazole led to improvement of non-HDL cholesterol levels and other metabolic parameters. Rates of efficacy failure were similar between groups, but switching to aripiprazole was associated with a higher rate of treatment discontinuation. In the context of close clinical monitoring, switching from an antipsychotic with high metabolic risk to one with lower risk to improve metabolic parameters is an effective strategy.

Figure 1

Enrollment and follow-up

Figure 2

Values are from efficacy evaluable population (n=187), and least squares means from the mixed model are presented. Change from baseline was the outcome variable, and treatment, week, baseline value, incoming medication, treatment by week interaction were covariates in the mixed model. P-value for NonHDL change is 0.0102, p-value for weight change is <.0001, and p-value for triglycerides change is 0.0020. Kaplan-Meier curves on intent-to-treat population (n=215). Logrank test p-value is 0.2993 for time to efficacy failure in days and 0.0021 for time to all-cause treatment discontinuation in days.

Figure 2

Values are from efficacy evaluable population (n=187), and least squares means from the mixed model are presented. Change from baseline was the outcome variable, and treatment, week, baseline value, incoming medication, treatment by week interaction were covariates in the mixed model. P-value for NonHDL change is 0.0102, p-value for weight change is <.0001, and p-value for triglycerides change is 0.0020. Kaplan-Meier curves on intent-to-treat population (n=215). Logrank test p-value is 0.2993 for time to efficacy failure in days and 0.0021 for time to all-cause treatment discontinuation in days.