Aripiprazole Found to Have Fewer Side Effects in Teens With First-Episode Psychosis

Young people with first-episode psychosis (FEP) who are treated with extended-release quetiapine gain more weight and experience worse metabolic effects—including increased lipids, insulin, triglycerides, and total cholesterol—than patients treated with aripiprazole, according to a report in the Journal of the Academy of Child and Adolescent Psychiatry.

“These differences emerged early, are clinically relevant, and should inform treatment choice for youths with early onset psychosis,” especially since studies have shown the two medications are equally effective in treating symptoms, say Karsten Gjessing Jensen, M.D., Ph.D., of the University of Copenhagen and colleagues.

The researchers analyzed data on 113 youth aged 12 to 17 with FEP who were randomized to 12 weeks of extended-release quetiapine (quetiapine-ER) or aripiprazole as part of the Tolerability and Efficacy of Antipsychotics trial. The trial was conducted from June 2010 to April 2014 in seven university child and adolescent psychiatry departments across Denmark.

The primary outcome was change in body weight; secondary outcomes were changes in body mass index (BMI), waist circumference, blood pressure, heart rate, and lipid and glucose metabolism measures. Patients were assessed and blood samples taken at 4 and 12 weeks. The researchers also examined family history for factors that might predict how youth would respond on weight and metabolic measures.

Treatment with quetiapine-ER was associated with greater weight gain at 4 and 12 weeks (2.24 kg and 4.88, respectively) than aripiprazole (0.45 kg at 4 weeks and 1.97 kg at 12 weeks). Patients treated with quetiapine-ER also had increased metabolic measures—including cholesterol, triglycerides, and hyperinsulinemia—than patients treated with aripiprazole. Of the patients in the quetiapine-ER group, 14% had metabolic syndrome at week 12 compared with 8.3% in the aripiprazole group. Family factors that predicted weight gain and BMI in youth were early weight gain, obesity, or type 2 diabetes.

The researchers noted that, aside from the health effects, weight gain is likely to be stigmatizing for young people who may already be marginalized because of their psychosis. “Youths with psychotic disorders are a highly vulnerable patient group who may already feel marginalized by their peers, so that a weight gain of 5 kg may be yet another cause of (self-)stigmatization that may increase the risk of treatment discontinuation and that may impair the alliance between patients and health care providers,” they wrote.

For related information, see the Psychiatric News article “SGAs Increase Teens’ Abdominal Fat, Decrease Insulin Sensitivity.”

(Image: fizkes/istock.com)

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