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Course and predictors of weight gain in people with first-episode psychosis treated with olanzapine or haloperidol

  • Robert B. Zipursky (a1), Hongbin Gu (a2), Alan I. Green (a3), Diana O. Perkins (a2), Mauricio F. Tohen (a4), Joseph P. McEvoy (a5), Stephen M. Strakowski (a6), Tonmoy Sharma (a7), René S. Kahn (a8), Raquel E. Gur (a9), Gary D. Tollefson (a4) and Jeffrey A. Lieberman (a10)...

Abstract

Background

Substantial weight gain is common with many atypical antipsychotics.

Aims

To evaluate the extent, time course and predictors of weight gain and its effect on study retention among people with first-episode psychosis treated with olanzapine or haloperidol.

Method

Survival analysis assessed time to potentially clinically significant weight gain (⩾7%) and the effect of weight gain on study retention. Weight gain during the 2-year study was summarised using last-observation-carried-forward (LOCF), observed cases and study completion approaches.

Results

After 2 years of treatment, LOCF mean weight gain was 10.2 kg (s.d.=10.1) for olanzapine (n=131) and 4.0 kg (s.d.=7.3) for haloperidol (n=132); observed cases mean weight gain was 15.4 kg (s.d.=10.0) for olanzapine and 7.5 kg (s.d.=9.2) for haloperidol. Change in body mass index was significantly predicted only by treatment group (P < 0.0001).

Conclusions

Olanzapine was associated with significantly greater weight gain than haloperidol, with both leading to greater weight gain than previously described.

Copyright

Corresponding author

Dr Robert B. Zipursky, Schizophrenia Programme, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, Canada M5T 1R8. Tel: +1 416 979 6913; fax: +1 416 979 4676; e-mail: robert_zipursky@camh.net

Footnotes

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Declaration of interest

This work was financially supported by Lilly Research Laboratories. M.F.T. and G.D.T. are employees of Lilly Research Laboratories.

Footnotes

References

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Course and predictors of weight gain in people with first-episode psychosis treated with olanzapine or haloperidol

  • Robert B. Zipursky (a1), Hongbin Gu (a2), Alan I. Green (a3), Diana O. Perkins (a2), Mauricio F. Tohen (a4), Joseph P. McEvoy (a5), Stephen M. Strakowski (a6), Tonmoy Sharma (a7), René S. Kahn (a8), Raquel E. Gur (a9), Gary D. Tollefson (a4) and Jeffrey A. Lieberman (a10)...
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eLetters

Comprehensive further review of safety of atypical and conventional antipsychotics is needed.

Mokhtar G E K N Isaac, Specialist Registrar Olad age and Genera;l Adult Psychiatry
05 December 2005

Editor, I read with grate interest the paper of “Course and predictors of weight gain in people with first-episode psychosis treated with olanzapine or haloperidol” by Zipursky, R. B. et all. It raises oncemore the issues of safety and tolerability of atypical and conventional antipsychotics. There are many publications that have looked at the issue of safety of atypical antipsychotics. Substantial evidence from a variety of studies showed side effects including diabetes, ketoacidosis, hyperglycaemia, obesity and lipid dysregulation in treated psychiatric patients (Baptista et al 2002; Bergman&Ader 2005; Gury 2004; Melkersson & Dahl 2004; Lieberman et al 2003; Newcomer 2004 and 2005).There have been more significant side effects for special age groups including risk of increased death in elderly with dementia (Schneider 2005; Layton 2005) and more metabolic risk for children and adolescent treated with some of the atypical antipsychotics (Toren 2004).Despite the limitations mentioned in Zipursky’s paper and the added limitation of the use of specific age group (16-40 years old) and the databeing collected more than 4 years ago, however the results are shedding more light on the harmful effects of some of the atypicals. I believe thata comprehensive review evaluating the real benefits and risks of both conventional and atypical antipsychotics is long overdue.

Baptista,T.’ Kin, N.M., Beaulieu, S., de Baptista,E.A. (2002) Obesityand related metabolic abnormalities during antipsychotic drug administration: mechanisms, management and research perspectives. Pharmacopsychiatry. 2002 Nov;35(6):205-19.

Bergman,R.N., Ader, M. (2005) Atypical antipsychotics and glucose homeostasis. J Clin Psychiatry. 2005 Apr;66(4):504-14.

Gury, C. (2004) Schizophrenia, diabetes mellitus and antipsychotics. Encephale. 2004 Jul-Aug;30(4):382-91.

Lindenmayer, J. P., Czobor, P., Volavka, J., et al (2003) Changes Changesin in glucose and cholesterol levels in patients with schizophreniatreated with typical or atypical antipsychotics. American Journal of Psychiatry, 160, 290 –296

Layton, D., Harris, S., Wilton, L.V., Shakir, S.A. Comparison of incidence rates of cerebrovascular accidents and transient ischaemic attacks in observational cohort studies of patients prescribed risperidone, quetiapine or olanzapine in general practice in England including patients with dementia. J Psychopharmacol. 2005 Sep;19(5):473-82.

Melkersson,K., Dahl, M.L. (2004) Adverse metabolic effects associated with atypical antipsychotics: literature review and clinical implications. Drugs. 2004;64(7):701-23.Newcomer, J.W.(2004) Metabolic risk during antipsychotic treatment. Clin Ther. 2004 Dec;26(12):1936-46.Newcomer, J.W. (2005) Second-generation (atypical) antipsychotics and metabolic effects: a comprehensive literature review. CNS Drugs. 2005;19 Suppl 1:1-93.

Schneider, L.S., Dagerman, K.S., Insel, P., (2005) Risk of death withatypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA. 2005 Oct 19;294(15):1934-43.

Toren, P., Ratner, S., Laor, N., Weizman, A. (2004) Benefit-risk assessment of atypical antipsychotics in the treatment of schizophrenia and comorbid disorders in children and adolescents. Drug Saf. 2004;27(14):1135-56.

Zipursky,R.b., Hongbin, G.u., Green, A. I., Perkins, D. O., et al. (2005) course and predictors of weight gain in people with first-episode psychosis treated with olanzapine or haloperido Br J Psychiatry 2005; 187:537-543
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