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Comparison of metabolic effects of ziprasidone versus olanzapine treatment in patients with first-episode schizophrenia

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Abstract

Objective

The objective of the study was to compare metabolic effects of ziprasidone versus olanzapine treatment in patients with first-episode schizophrenia.

Methods

In this 6-week, multicenter, open-label trial, 260 patients were randomly assigned to receive ziprasidone or olanzapine treatment (130 per group). Primary metabolic measures were changes in weight and body mass index (BMI). Secondary metabolic measures were changes in glucose, insulin, lipids, and blood pressure. Efficacy and safety were also measured additionally.

Results

A total number of 230 patients completed the study. The mean daily dosages were 138.2(28.6) mg for ziprasidone and 19.0(2.3) mg for olanzapine. After 6-week treatment, there were significant between-group differences in change scores on weight [4.22(3.49) kg versus −0.84(2.04) kg, p < 0.001] and BMI [1.59(1.37) versus −0.30(0.74), p < 0.001]. In addition, there were significant between-group differences in change scores on fasting plasma glucose, insulin, homeostasis model assessment 2-insulin resistance, low-density lipoprotein, total cholesterol, and triglycerides (p < 0.001); all the changes were clinically in favor of ziprasidone treatment. Both medications were effective in improving schizophrenia symptoms, but the decreases in Positive and Negative Syndrome Scale total scores of the olanzapine group were significantly greater than that of the ziprasidone group (p < 0.05). Compared with olanzapine, ziprasidone also induced more prolonging of corrected QT interval and extrapyramidal side effects (p < 0.05). Both medications were well tolerated, and no serious adverse events were observed in either group.

Conclusions

Compared with olanzapine, ziprasidone treatment was associated with less adverse effects on glucose and lipid metabolism in patients with first-episode schizophrenia.

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References

  • Alptekin K, Hafez J, Brook S, Akkaya C, Tzebelikos E, Ucok A, El Tallawy H, Danaci AE, Lowe W, Karayal ON (2009) Efficacy and tolerability of switching to ziprasidone from olanzapine, risperidone or haloperidol: an international, multicenter study. Int Clin Psychopharmacol 24:229–238

    Article  PubMed  Google Scholar 

  • Breier A, Berg PH, Thakore JH, Naber D, Gattaz WF, Cavazzoni P, Walker DJ, Roychowdhury SM, Kane JM (2005) Olanzapine versus ziprasidone: results of a 28-week double-blind study in patients with schizophrenia. Am J Psychiatry 162:1879–1887

    Article  PubMed  Google Scholar 

  • Brown RR, Estoup MW (2005) Comparison of the metabolic effects observed in patients treated with ziprasidone versus olanzapine. Int Clin Psychopharmacol 20:105–112

    Article  PubMed  Google Scholar 

  • Dossenbach M, Treuer T, Kryzhanovskaya L, Saylan M, Dominguez S, Huang X (2007) Olanzapine versus chlorpromazine in the treatment of schizophrenia: a pooled analysis of four 6-week, randomized, open-label studies in the Middle East and North Africa. J Clin Psychopharmacol 27:329–337

    Article  PubMed  CAS  Google Scholar 

  • Garman PM, Ried LD, Bengtson MA, Hsu C, McConkey JR (2007) Effect on lipid profiles of switching from olanzapine to another second-generation antipsychotic agent in veterans with schizophrenia. J Am Pharm Assoc: JAPhA 47:373–378

    Article  Google Scholar 

  • Gordon DJ, Probstfield JL, Garrison RJ, Neaton JD, Castelli WP, Knoke JD, Jacobs DR Jr, Bangdiwala S, Tyroler HA (1989) High-density lipoprotein cholesterol and cardiovascular disease. Four prospective American studies. Circulation 79:8–15

    Article  PubMed  CAS  Google Scholar 

  • Grootens KP, van Veelen NM, Peuskens J, Sabbe BG, Thys E, Buitelaar JK, Verkes RJ, Kahn RS (2011) Ziprasidone vs olanzapine in recent-onset schizophrenia and schizoaffective disorder: results of an 8-week double-blind randomized controlled trial. Schizophr Bull 37:352–361

    Article  PubMed  CAS  Google Scholar 

  • Henderson DC (2007) Weight gain with atypical antipsychotics: evidence and insights. J clin psychiatry 68(Suppl 12):18–26

    PubMed  CAS  Google Scholar 

  • Hokanson JE, Austin MA (1996) Plasma triglyceride level is a risk factor for cardiovascular disease independent of high-density lipoprotein cholesterol level: a meta-analysis of population-based prospective studies. J Cardiovasc Risk 3:213–219

    Article  PubMed  CAS  Google Scholar 

  • Ip S, Lichtenstein AH, Chung M, Lau J, Balk EM (2009) Systematic review: association of low-density lipoprotein subfractions with cardiovascular outcomes. Ann Intern Med 150:474–484

    PubMed  Google Scholar 

  • Kahn RS, Fleischhacker WW, Boter H, Davidson M, Vergouwe Y, Keet IP, Gheorghe MD, Rybakowski JK, Galderisi S, Libiger J, Hummer M, Dollfus S, Lopez-Ibor JJ, Hranov LG, Gaebel W, Peuskens J, Lindefors N, Riecher-Rossler A, Grobbee DE (2008) Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial. Lancet 371:1085–1097

    Article  PubMed  CAS  Google Scholar 

  • Komossa K, Rummel-Kluge C, Hunger H, Schmid F, Schwarz S, Duggan L, Kissling W, Leucht S (2010) Olanzapine versus other atypical antipsychotics for schizophrenia. Cochrane Database Syst Rev: CD006654

  • Komossa K, Rummel-Kluge C, Hunger H, Schwarz S, Bhoopathi PS, Kissling W, Leucht S (2009) Ziprasidone versus other atypical antipsychotics for schizophrenia. Cochrane Database Syst Rev: CD006627

  • Law MR, Wald NJ (1994) An ecological study of serum cholesterol and ischaemic heart disease between 1950 and 1990. Eur J Clin Nutr 48:305–325

    PubMed  CAS  Google Scholar 

  • Leucht S, Barnes TR, Kissling W, Engel RR, Correll C, Kane JM (2003) Relapse prevention in schizophrenia with new-generation antipsychotics: a systematic review and exploratory meta-analysis of randomized, controlled trials. Am J Psychiatry 160:1209–1222

    Article  PubMed  Google Scholar 

  • Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO, Keefe RS, Davis SM, Davis CE, Lebowitz BD, Severe J, Hsiao JK (2005) Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 353:1209–1223

    Article  PubMed  CAS  Google Scholar 

  • Lublin H, Haug HJ, Koponen H, Sigmundsson T, Kolb SA (2009) Ziprasidone versus olanzapine, risperidone or quetiapine in patients with chronic schizophrenia: a 12-week open-label, multicentre clinical trial. world j biol psychiatry: off j World Fed Soc Biol Psychiatry 10:710–718

    Google Scholar 

  • McEvoy JP, Meyer JM, Goff DC, Nasrallah HA, Davis SM, Sullivan L, Meltzer HY, Hsiao J, Scott Stroup T, Lieberman JA (2005) Prevalence of the metabolic syndrome in patients with schizophrenia: baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophr Res 80:19–32

    Article  PubMed  Google Scholar 

  • Miller BJ, Paschall CB, Svendsen DP (2006) Mortality and medical comorbidity among patients with serious mental illness. Psychiatr Serv 57:1482–1487

    Article  PubMed  Google Scholar 

  • Mottillo S, Filion KB, Genest J, Joseph L, Pilote L, Poirier P, Rinfret S, Schiffrin EL, Eisenberg MJ (2010) The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis. J Am Coll Cardiol 56:1113–1132

    Article  PubMed  Google Scholar 

  • Olsson AG (2010) HDL and LDL as therapeutic targets for cardiovascular disease prevention: the possible role of niacin. Nutr Metab Cardiovasc Dis 20:553–557

    Article  PubMed  CAS  Google Scholar 

  • Rummel-Kluge C, Komossa K, Schwarz S, Hunger H, Schmid F, Kissling W, Davis JM, Leucht S (2012) Second-generation antipsychotic drugs and extrapyramidal side effects: a systematic review and meta-analysis of head-to-head comparisons. Schizophr Bull 38:167–177

    Article  PubMed  Google Scholar 

  • Rummel-Kluge C, Komossa K, Schwarz S, Hunger H, Schmid F, Lobos CA, Kissling W, Davis JM, Leucht S (2010) Head-to-head comparisons of metabolic side effects of second generation antipsychotics in the treatment of schizophrenia: a systematic review and meta-analysis. Schizophr Res 123:225–233

    Article  PubMed  Google Scholar 

  • Sachs GS, Guille C (1999) Weight gain associated with use of psychotropic medications. J clin psychiatry 60(Suppl 21):16–19

    PubMed  Google Scholar 

  • Simpson GM, Glick ID, Weiden PJ, Romano SJ, Siu CO (2004) Randomized, controlled, double-blind multicenter comparison of the efficacy and tolerability of ziprasidone and olanzapine in acutely ill inpatients with schizophrenia or schizoaffective disorder. Am J Psychiatry 161:1837–1847

    Article  PubMed  Google Scholar 

  • Simpson GM, Weiden P, Pigott T, Murray S, Siu CO, Romano SJ (2005) Six-month, blinded, multicenter continuation study of ziprasidone versus olanzapine in schizophrenia. Am J Psychiatry 162:1535–1538

    Article  PubMed  Google Scholar 

  • Strom BL, Eng SM, Faich G, Reynolds RF, D’Agostino RB, Ruskin J, Kane JM (2011) Comparative mortality associated with ziprasidone and olanzapine in real-world use among 18,154 patients with schizophrenia: the Ziprasidone Observational Study of Cardiac Outcomes (ZODIAC). Am J Psychiatry 168:193–201

    Article  PubMed  Google Scholar 

  • Tiihonen J, Lonnqvist J, Wahlbeck K, Klaukka T, Niskanen L, Tanskanen A, Haukka J (2009) 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet 374:620–627

    Article  PubMed  Google Scholar 

  • Wallace TM, Levy JC, Matthews DR (2004) Use and abuse of HOMA modeling. Diabetes Care 27:1487–1495

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by the Pfizer Inc., the National Natural Science Foundation of China (Grant No. 30971052 to RRW), and National R&D Special Program for Health Professions (Grant No. 201002003 to JPZ). Dr. Wu expresses her gratitude to the World Psychiatric Association for providing financial support for her fellowship.

Conflict of interest

All authors declared no conflict of interest. The only role of Pfizer Inc. was in the monitoring. The company had no further role in the study design, collection, analysis, and interpretation of data and writing the reports. The company also had no role in the decision to submit the paper for publication.

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Authors and Affiliations

  1. Institute of Mental Health of the Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, People’s Republic of China

    Jian-Jun Ou, Juan Wang, Xiao-Feng Guo, Ren-Rong Wu & Jing-Ping Zhao

  2. The First Affiliated Hospital of Medical School of Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, People’s Republic of China

    Yi Xu

  3. Wuhan Mental Health Center, 70 Qiaokou Youyi Road, Wuhan, 430022, Hubei, People’s Republic of China

    Hong-Hui Chen

  4. UMass Memorial Medical Center, University of Massachusetts Medical School, Biotech One, Suite 100, 365 Plantation Street, Worcester, MA, 01605, USA

    Xiaoduo Fan

  5. Department Psychiatry, Case Western Reserve/University Hospital Case Medical Center, Cleveland, OH, 44106, USA

    Keming Gao

  6. The Hangzhou Seventh People Hospital, Hangzhou, 310001, Zhejiang, People’s Republic of China

    Jing-Ping Zhao

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  1. Jian-Jun Ou
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  2. Yi Xu
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  4. Xiaoduo Fan
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  6. Juan Wang
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  7. Xiao-Feng Guo
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  8. Ren-Rong Wu
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  9. Jing-Ping Zhao
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Corresponding authors

Correspondence to Ren-Rong Wu or Jing-Ping Zhao.

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Ou, JJ., Xu, Y., Chen, HH. et al. Comparison of metabolic effects of ziprasidone versus olanzapine treatment in patients with first-episode schizophrenia. Psychopharmacology 225, 627–635 (2013). https://doi.org/10.1007/s00213-012-2850-6

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  • DOI: https://doi.org/10.1007/s00213-012-2850-6

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