Comparison of Four Atypical Antipsychotics (Aripiprazole, Olanzapine, Quetiapine, and Risperidone) in Pt > Age 40

Comparison of Longer-Term Safety and Effectiveness of 4 Atypical Antipsychotics (Aripiprazole, Olanzapine, Quetiapine, and Risperidone) in Patients Over Age 40

Source: J Clin Psychiatry, Online ahead of print: November 27, 2012

Methods:
Patients were followed for up to 2 years, with assessments at baseline, 6 weeks, 12 weeks, and every 12 weeks thereafter. Medications were administered employing open-label design and flexible dosages, but with blind raters. The study was conducted from October 2005 to October 2010.

Outcome Measures:
- Primary metabolic markers (body mass index, blood pressure, fasting blood glucose, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides)
- % of patients who stay on the randomly assigned atypical antipsychotic for at least 6 months
- Psychopathology
- % of patients who develop metabolic syndrome
- % of patients who develop serious and nonserious adverse events.

Results:
- Because of a high incidence of serious adverse events, Quetiapine was discontinued midway through the trial.
- There were significant differences among patients willing to be randomized to different atypical antipsychotics (P < .01), suggesting that treating clinicians tended to exclude olanzapine and prefer aripiprazole as one of the possible choices in patients with metabolic problems.
- Yet, the atypical antipsychotic groups did not differ in longitudinal changes in metabolic parameters or on most other outcome measures.
- High discontinuation rate (median duration 26 weeks prior to discontinuation)
- Lack of significant improvement in psychopathology
- High cumulative incidence of metabolic syndrome (36.5% in 1 year) and of serious (23.7%) and nonserious (50.8%) adverse events for all atypical antipsychotics in the study.

Conclusions:
- Lack of effectiveness and a high incidence of side effects with four commonly prescribed atypical antipsychotics across diagnostic groups in patients over age 40, with relatively few differences among the drugs.
- Caution in the use of these drugs is warranted in middle-aged and older patients.