Long-Term Evolution of Metabolic Status in Patients with Schizophrenia Stably Maintained on Second-Generation Antipsychotics

Abstract

Objective: Second-generation antipsychotics (SGAs) increase the risk of metabolic syndrome (MetS). Despite the risk of MetS, SGAs may have to be continued with change in some patients. The aim of this study was to trace the evolution of MetS in these patients.

Methods: Patients with schizophrenia who had been maintained on a fixed SGA regimen for more than a year were followed-up without changing the regimen. Metabolic indicators were evaluated at baseline and at follow-up. Prevalence, incidence and spontaneous normalization rate of MetS were estimated. Risk factors that might have influenced the evolution were scrutinized.

Results: A total of 151 subjects were included. During the mean observation period of 389.9±162.4 days, the prevalence of MetS was increased from 35.1 to 45.0%. The incidence rate was 29.6%, while the normalization rate was 26.4%, risk factors affecting incidence were age (OR=1.09, 95% CI: 1.03-1.17), baseline continuous values of metabolic syndrome risk scores (cMetS, OR=1.77, 95% CI:1.29-2.55) and baseline body weight (OR=1.06, 95% CI: 1.01-1.13). Normalization was influenced by age (OR=0.74, 95% CI: 0.57-0.89) and baseline body weight (OR=0.85, 95% CI: 0.72-0.95).

Conclusion: The prevalence of MetS steadily increased with the continuous use of SGAs. However, individual difference was extensive and about a quarter of the patients were able to recover naturally without specific measurements.

Keywords: Incidence; Metabolic syndrome; Normalization; Schizophrenia; Second-generation antipsychotics.

Figure 1.

The sex-associated changes of various metabolic indicators over time during the follow-up period. The depicted lines were the conditional mean lines smoothed by linear mixed-effect regression. Gray areas were 95% confidence intervals. cMetS: continuous values of metabolic syndrome risk scores, FBS: fasting blood sugar, TG: triglycerides, HDL: high density lipoprotein, WC: waist circumference, sBP: systolic blood pressure, dBP: diastolic blood pressure, BMI: basal metabolic index, F: female, M: male.