Metabolic risks remain largely unmonitored in Medicaid patients taking antipsychotics

Despite government warnings and professional recommendations about diabetes risks associated with second-generation antipsychotic drugs, fewer than one-third of Medicaid patients who are treated with these medications undergo blood glucose or lipid tests, according to a new report.

Researchers studied laboratory claims data from the Medicaid populations of California, Missouri and Oregon between 2002 and 2005. They compared metabolic testing rates between a group of 109,451 patients receiving second-generation antipsychotics (aripiprazole, olanzapine, olanzapine/fluoxetine, quetiapine, risperidone or ziprasidone) and a control group of 203,527 patients who began taking albuterol but not an antipsychotic.

Initial testing rates for patients treated with second-generation antipsychotics were low — 27% underwent glucose testing and 10% underwent lipid testing.

In 2003, the FDA started requiring a warning on labels of second-generation antipsychotics, including olanzapine, fluoxetine and risperidone, describing an increased risk for hyperglycemia and diabetes. The warning stated that glucose levels should be monitored in patients with diabetes, at risk for the disease or with symptoms of hyperglycemia. At the same time, the American Diabetes Association and American Psychiatric Association published a consensus statement describing the metabolic risks associated with second-generation antipsychotics and specifying a monitoring protocol for all patients receiving these medications.

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Most Second-Generation Antipsychotics Effective for Treatment of Negative Schizophrenia Symptoms: Presented at EPA

Amisulpride and ziprasidone show better overall effects in comparison with other second-generation antipsychotics in the of negative symptoms of schizophrenia, according to results of 2 meta-analyses of randomised controlled trials.

Principal investigator Javier Rejas, MD, PhD, Medical Unit, Health Outcomes Research, Pfizer España, Madrid, Spain, presented these results on January 27 here at the 17th European Congress of Psychiatry, organised by the European Psychiatric Association (EPA).

While research has demonstrated the efficacy of numerous first-generation antipsychotics, such as haloperidol, for treatment of positive symptoms of schizophrenia, negative symptoms are difficult to treat and can result in severe impairment and poor quality of life, said Dr. Rejas.

His research team therefore conducted 2 meta-analyses to compare the efficacy of second-generation antipsychotics versus haloperidol and versus placebo in the treatment of negative schizophrenia symptoms.

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Old Schizophrenia Drug Fights Violence as Effectively as Second-Generation Antipsychotics

The newer, atypical antipsychotics were no better than a first-generation agent in reducing violent behavior in schizophrenic patients, researchers here said.

Among 1,445 patients randomly assigned to one of five antipsychotic drugs, the overall proportion showing violent behavior declined from 19% at baseline to 14% after six months on an intent-to-treat basis, with no differences seen between different medications, reported Marvin Swartz, M.D., of Duke University, and colleagues in the July 1 issue of the British Journal of Psychiatry.

They conducted a new analysis of data from the initial randomization phase of the prospective, double-blind Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) project, a multi-center trial comparing the effectiveness of different drugs for schizophrenia.

"Contrary to high expectations and some previous research, this study did not show an advantage for second-generation antipsychotics in violence risk reduction when compared with perphenazine, a representative first-generation antipsychotic," the researchers wrote.

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