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. 2017 Nov 21;17(1):373.
doi: 10.1186/s12888-017-1539-0.

The metabolic side effects of 12 antipsychotic drugs used for the treatment of schizophrenia on glucose: a network meta-analysis

Yangyu Zhang  1 , Yingyu Liu  1 , Yingying Su  1 , Yueyue You  1 , Yue Ma  1 , Guang Yang  1 , Yan Song  1 , Xinyu Liu  1 , Mohan Wang  1 , Lili Zhang  1 , Changgui Kou  2
Affiliations

The metabolic side effects of 12 antipsychotic drugs used for the treatment of schizophrenia on glucose: a network meta-analysis

Yangyu Zhang et al. BMC Psychiatry. .

Abstract

Background: Antipsychotics have serious metabolic side effects on blood glucose. However, the comparative influence of these drugs on blood glucose levels has not been comprehensively evaluated. We conducted a network meta-analysis to create a hierarchy of the side effects of 12 antipsychotic drugs on changes in blood glucose levels.

Methods: A systematic search of the PubMed, EMBASE and Cochrane databases (last search June 2016) was conducted to identify studies that reported randomized controlled trials (RCTs) comparing changes in blood glucose levels between patients receiving one of 12 antipsychotic drugs or a placebo for the treatment of schizophrenia or related disorders. The studies we searched were limited to those published in English. Two reviewers independently extracted data. The primary outcome of interest was changes in fasting glucose levels.

Results: We included 47 studies with 114 relevant arms. Of the antipsychotic drugs, only olanzapine was associated with significantly increased glucose levels compared to a placebo (mean difference (MD) = 3.95, 95% confidence interval (CI) = 0.14 to 7.76). Moreover, olanzapine was associated with a significantly greater change in the glucose levels than ziprasidone (MD = 5.51, 95% CI = 1.62 to 9.39), lurasidone (MD = 5.58, 95% CI = 0.53 to 10.64) or risperidone (MD = 3.05, 95% CI = 0.87 to 5.22). Ziprasidone and lurasidone were associated with minimal glucose changes compared to the other antipsychotics.

Conclusions: Olanzapine was associated with a significantly greater change in blood glucose levels than ziprasidone, lurasidone, risperidone or placebo treatment. The application of a hierarchy of glucose metabolism-related side effects may help clinicians tailor the choice of antipsychotic drug to meet the needs of individual patients.

Keywords: Antipsychotic drug; Glucose change; Network meta-analysis; RCTs.

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Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Flowchart diagram of randomized controlled trials reporting glucose change
Fig. 2
Fig. 2
Network of treatment comparisons for glucose changes. PLA = placebo. AMI = amisulpride. ARI = aripiprazole. ASE = asenapine. CLO = clozapine. HAL = haloperidol. LURA = lurasidone. OLA = olanzapine. PAL = paliperidone. QUE = quetiapine. RIS = risperidone. SER = sertindole. ZIP = ziprasidone
Fig. 3
Fig. 3
Glucose changes associated with antipsychotic drugs. Drugs are reported in order of their glucose change rankings. Comparisons between treatments should be read from left to right. The estimate is reported for the cell type in common between the column-defining treatment and the row-defining treatment. Mean differences (MDs) lower than 0 favor the column-defining treatment. Significant results are in bold. ZIP = ziprasidone. LUR = lurasidone. PLA = placebo. ARI = aripiprazole. RIS = risperidone. AMI = amisulpride. QUE = quetiapine. PAL = paliperidone. ASE = asenapine. HAL = haloperidol. SER = sertindole. CLO = clozapine. OLA = olanzapine
Fig. 4
Fig. 4
Forest plot for glucose changes associated with antipsychotics drugs compared with placebo treatment. Treatments are ranked based on their surface under the cumulative ranking (SUCRA) values
See this image and copyright information in PMC

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