Department of Psychiatry, Hospital Clínic, University of Barcelona, Idibaps, Cibersam, Barcelona, Spain.
Institute of Neurosciences, University of Granada, Granada, Spain.
Adv Ther. 2021 May;38(5):2491-2512. doi: 10.1007/s12325-021-01689-8. Epub 2021 Apr 7.
To assess the risk of occurrence and potential determinants of metabolic disorders in adult patients treated with second-generation antipsychotics (SGAs) under real-world practice conditions.
MEDLINE, EMBASE, and PsycInfo were searched in July 2019 from database inception. We included population-based, longitudinal, comparative studies that report the results of the outcomes of interest for adult participants, including diabetes, ketoacidosis, hyperosmolar hyperglycemic state, weight gain/obesity, dyslipidemia, hypertension, and metabolic syndrome. Two reviewers independently extracted data on the study design, study quality, and study outcomes.
We included 40 studies. Most studies showed that clozapine and olanzapine were associated with an increased likelihood of developing diabetes, while the results for risperidone and quetiapine were mixed. Although less well studied, ziprasidone and aripiprazole appeared to not be associated with the occurrence of diabetes. Information on antipsychotic-induced weight gain/obesity is extremely scarce. Regarding dyslipidemia, aripiprazole was not associated with an increased likelihood of developing dyslipidemia, clozapine was associated with an increased likelihood of developing dyslipidemia, and risperidone, olanzapine, quetiapine, and ziprasidone showed mixed results. Two studies suggested an association between ziprasidone and the occurrence of hypertension. Several studies found that the occurrence of a metabolic disorder acted as a risk factor for the development of other metabolic disorders. We did not find information on brexpiprazole, cariprazine, or lurasidone, and data on any long-acting SGA were lacking.
Although there are relevant differences among SGAs concerning the risk of metabolic disorders, it appears that none of the SGAs included in our review are fully devoid of these disturbances.
在真实实践条件下，评估第二代抗精神病药物（SGAs）治疗的成年患者发生代谢紊乱的风险及其潜在决定因素。
2019 年 7 月，从数据库建立开始，我们在 MEDLINE、EMBASE 和 PsycInfo 中进行了搜索。我们纳入了基于人群的、纵向的、比较性研究，这些研究报告了包括糖尿病、酮症酸中毒、高渗性高血糖状态、体重增加/肥胖、血脂异常、高血压和代谢综合征等感兴趣结局的成年参与者的结果。两位审查员独立提取了研究设计、研究质量和研究结果的数据。
我们纳入了 40 项研究。大多数研究表明，氯氮平与奥氮平与发生糖尿病的可能性增加相关，而利培酮和喹硫平的结果则不一致。尽管研究较少，但齐拉西酮和阿立哌唑似乎与糖尿病的发生无关。关于抗精神病药引起的体重增加/肥胖的信息极其缺乏。关于血脂异常，阿立哌唑与发生血脂异常的可能性增加无关，氯氮平与发生血脂异常的可能性增加相关，而利培酮、奥氮平、喹硫平和齐拉西酮的结果则不一致。两项研究表明齐拉西酮与高血压的发生有关。几项研究发现，代谢紊乱的发生是其他代谢紊乱发生的危险因素。我们没有找到关于布瑞哌唑、卡利培酮或鲁拉西酮的信息，也缺乏任何长效 SGA 的数据。
尽管在 SGAs 发生代谢紊乱的风险方面存在相关差异，但似乎我们纳入的审查中的任何一种 SGA 都没有完全没有这些紊乱。
