Garman Patrick M, Ried L Douglas, Bengtson Michael A, Hsu Chienning, McConkey Joel R
College of Pharmacy, University of Florida, Gainesville, FL, USA.
J Am Pharm Assoc (2003). 2007 May-Jun;47(3):373-8. doi: 10.1331/JAPhA.2007.06090.
To compare (1) mean low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride differences after switching from olanzapine to quetiapine, risperidone, or ziprasidone and (2) the mean lipid change between switch patterns.
Retrospective, naturalistic, nonequivalent control group design.
United States between April 1, 2002, and September 30, 2002.
1,826 U.S. Veterans Healthcare System enrollees with diagnoses of schizophrenia or schizoaffective disorders and receiving a second-generation antipsychotic (SGA) medication.
Analysis of data from the Veterans Information Systems and Technology Architecture.
Differences in LDL-C, HDL-C, and triglycerides and mean differences between switch patterns. Predictors were the type of switch (e.g., olanzapine to quetiapine) and switch patterns (e.g., olanzapine to quetiapine versus olanzapine to risperidone). Data were analyzed using Pearson's X2 and multivariate analysis of covariance with planned comparisons.
After adjusting for age, gender, and race/ethnicity, LDL-C decreased significantly among patients switched from olanzapine to ziprasidone (-16.9 mg/dL, P <0.01) and olanzapine to quetiapine (-7.6 mg/dL, P = 0.04) and trended upward in patients switched from olanzapine to risperidone (+6.6 mg/dL, P = 0.12). Triglyceride levels decreased among those switched from olanzapine to ziprasidone (-62.9 mg/dL, P <0.01) and olanzapine to risperidone (-48.5 mg/dL, P <0.01) but not among veterans switched from olanzapine to quetiapine (+7.8 mg/dL, P = 0.54). HDL-C levels did not change significantly when veterans were switched from olanzapine to quetiapine, risperidone, or ziprasidone.
Switching SGAs can increase or decrease cardiovascular risk depending on the clinician's follow-on SGA choice. LDL-C and triglyceride levels decreased significantly among veterans switched from olanzapine to ziprasidone. Switching to quetiapine was associated with a reduction in LDL-C, while switching to risperidone resulted in lower triglyceride levels. Clinicians should use these results when building a patient care plan that includes switching of SGAs.
比较（1）从奥氮平换用喹硫平、利培酮或齐拉西酮后低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）和甘油三酯的平均差异，以及（2）不同换药模式之间的平均血脂变化。
回顾性、自然主义、非等效对照组设计。
2002年4月1日至2002年9月30日期间的美国。
1826名美国退伍军人医疗系统的登记患者，诊断为精神分裂症或分裂情感性障碍，正在接受第二代抗精神病药物（SGA）治疗。
对退伍军人信息系统和技术架构中的数据进行分析。
LDL-C、HDL-C和甘油三酯的差异以及不同换药模式之间的平均差异。预测因素为换药类型（如从奥氮平换为喹硫平）和换药模式（如从奥氮平换为喹硫平与从奥氮平换为利培酮）。使用Pearson卡方检验和带有计划比较的多变量协方差分析对数据进行分析。
在对年龄、性别和种族/民族进行调整后，从奥氮平换为齐拉西酮的患者LDL-C显著降低（-16.9mg/dL，P<0.01），从奥氮平换为喹硫平者LDL-C也显著降低（-7.6mg/dL，P = 0.04），而从奥氮平换为利培酮的患者LDL-C呈上升趋势（+6.6mg/dL，P = 0.12）。从奥氮平换为齐拉西酮的患者甘油三酯水平降低（-62.9mg/dL，P<0.01），从奥氮平换为利培酮的患者甘油三酯水平也降低（-48.5mg/dL，P<0.01），但从奥氮平换为喹硫平的退伍军人甘油三酯水平未降低（+7.8mg/dL，P = 0.54）。当退伍军人从奥氮平换为喹硫平、利培酮或齐拉西酮时，HDL-C水平无显著变化。
更换SGA可能增加或降低心血管风险，这取决于临床医生后续选择的SGA。从奥氮平换为齐拉西酮的退伍军人LDL-C和甘油三酯水平显著降低。换用喹硫平与LDL-C降低有关，而换用利培酮导致甘油三酯水平降低。临床医生在制定包括更换SGA的患者护理计划时应参考这些结果。
