Abstract
Background
Antipsychotics have serious metabolic adverse effects on lipid parameters. However, the comparative influence of antipsychotics on lipid parameter levels has not been comprehensively evaluated. We conducted a systematic review and meta-analysis to evaluate the adverse effects of antipsychotics on changes in total cholesterol, LDL cholesterol, and triglyceride levels.
Methods
A systematic literature searches of the PubMed, EMBASE, Scopus, and Cochrane databases (last search Oct. 2018) was conducted to identify studies that reported randomized placebo-controlled trials (RCTs) comparing changes in total cholesterol, LDL cholesterol, and triglyceride levels between patients receiving antipsychotic or a placebo for the treatment of schizophrenia or related disorders. The primary outcome of interest was mean changes from baseline in those lipid parameter levels.
Results
We included 25, 22, and 27 studies reporting changes in total cholesterol, LDL cholesterol, and triglyceride levels, respectively. Of the 9 antipsychotics, olanzapine, quetiapine, and risperidone were associated with significantly increased total cholesterol compared to a placebo (standardized mean difference (SMD) = 0.43, 95% confidence interval (CI) = 0.28 to 0.57, p < 0.001; SMD = 0.41, 95% CI = 0.29 to 0.54, p < 0.001; SMD = 0.20, 95% CI = 0.05 to 0.36, p = 0.011, respectively).
Of the 8 antipsychotics, olanzapine and quetiapine were associated with significantly increased, and cariprazine was associated with significantly decreased LDL cholesterol compared to a placebo (SMD=0.32, 95% CI= 0.18 to 0.47, p<0.001; SMD=0.26, 95% CI=0.11 to 0.40, p=0.001; SMD = -0.16, 95% CI = -0.27 to -0.06, p=0.003, respectively).
Of the 10 antipsychotics, olanzapine, quetiapine, and risperidone were associated with significantly increased triglyceride compared to a placebo (SMD = 0.42, 95% CI = 0.31 to 0.52, p < 0.001; SMD = 0.32, 95% CI = 0.20 to 0.44, p < 0.001; SMD = 0.17, 95% CI = 0.02 to 0.33, p = 0.029, respectively).
Discussion
Olanzapine, quetiapine and risperidone were associated with significantly greater change in lipid parameter levels than placebo treatment. The comparative influence of lipid parameter-related side effects may help clinicians tailor the choice of antipsychotics to meet the needs of individual patients.