TY - JOUR

T1 - Cardiometabolic Adverse Effects and Its Predictors in Children and Adolescents With First-Episode Psychosis During Treatment With Quetiapine-Extended Release Versus Aripiprazole

T2 - 12-Week Results From the Tolerance and Effect of Antipsychotics in Children and Adolescents With Psychosis (TEA) Trial

AU - Jensen, Karsten Gjessing

AU - Correll, Christoph U

AU - Rudå, Ditte

AU - Klauber, Dea Gowers

AU - Decara, Marie Stentebjerg

AU - Fagerlund, Birgitte

AU - Jepsen, Jens Richardt Møllegaard

AU - Eriksson, Frank

AU - Fink-Jensen, Anders

AU - Pagsberg, Anne Katrine

N1 - Copyright © 2019. Published by Elsevier Inc.

PY - 2019

Y1 - 2019

N2 - OBJECTIVE: To investigate cardiometabolic effects and its predictors in youth with first-episode psychosis (FEP) treated with quetiapine-extended release (ER) vs. aripiprazole.METHOD: Youths with FEP aged 12-17 years were randomized to quetiapine-ER or aripiprazole in the 12-week, double-blinded, Tolerability and Efficacy of Antipsychotics (TEA) trial. Primary outcome was change in body weight; secondary outcomes were changes in body mass index (BMI) and waist circumference (WC), blood pressure (BP), heart rate, and lipid and glucose metabolism parameters. Possible predictors of cardiometabolic changes were examined.RESULTS: Altogether, 113 patients (schizophrenia-spectrum disorders=93%, age (mean±SD): 15.7±1.4 years, male participants=30.1%), were randomized to quetiapine-ER (n=55) or aripiprazole (n=58). Quetiapine-ER led to significant increases in body weight (4.88 kg, 95% confidence interval (CI): 3.92-5.83, p<.0001), BMI z-score (0.43, 95%CI= 0.33-0.53, p<0.0001) and WC z-score (0.97, CI=0.7-1.23, p<0.0001). Changes were significantly smaller with aripiprazole (all between-group p-values p<0.0001): body weight: 1.97 kg (CI=0.97-2.97, p=0.0001), BMI z-score: 0.10 (CI: -0.01-0.20, p=0.0646) and WC z-score: 0.18 (CI: -0.09-0.45, p=0.1968). Lipid and glucose metabolism parameters increased significantly at week 4 and 12 only with quetiapine-ER (p-range: 0.0001-0.037). Quetiapine-ER was associated with an increased occurrence of obesity, elevated blood lipids and hyperinsulinemia (p-range=0.004-0.039). Early weight gain, obesity or type 2 diabetes in the family significantly predicted weight and BMI gain at week 12.CONCLUSION: In youth with FEP, quetiapine-ER was associated with significantly greater weight gain and adverse changes in metabolic outcomes than aripiprazole. Early weight gain must be addressed and family lifestyle factors taken into consideration when treating youth with antipsychotics.

AB - OBJECTIVE: To investigate cardiometabolic effects and its predictors in youth with first-episode psychosis (FEP) treated with quetiapine-extended release (ER) vs. aripiprazole.METHOD: Youths with FEP aged 12-17 years were randomized to quetiapine-ER or aripiprazole in the 12-week, double-blinded, Tolerability and Efficacy of Antipsychotics (TEA) trial. Primary outcome was change in body weight; secondary outcomes were changes in body mass index (BMI) and waist circumference (WC), blood pressure (BP), heart rate, and lipid and glucose metabolism parameters. Possible predictors of cardiometabolic changes were examined.RESULTS: Altogether, 113 patients (schizophrenia-spectrum disorders=93%, age (mean±SD): 15.7±1.4 years, male participants=30.1%), were randomized to quetiapine-ER (n=55) or aripiprazole (n=58). Quetiapine-ER led to significant increases in body weight (4.88 kg, 95% confidence interval (CI): 3.92-5.83, p<.0001), BMI z-score (0.43, 95%CI= 0.33-0.53, p<0.0001) and WC z-score (0.97, CI=0.7-1.23, p<0.0001). Changes were significantly smaller with aripiprazole (all between-group p-values p<0.0001): body weight: 1.97 kg (CI=0.97-2.97, p=0.0001), BMI z-score: 0.10 (CI: -0.01-0.20, p=0.0646) and WC z-score: 0.18 (CI: -0.09-0.45, p=0.1968). Lipid and glucose metabolism parameters increased significantly at week 4 and 12 only with quetiapine-ER (p-range: 0.0001-0.037). Quetiapine-ER was associated with an increased occurrence of obesity, elevated blood lipids and hyperinsulinemia (p-range=0.004-0.039). Early weight gain, obesity or type 2 diabetes in the family significantly predicted weight and BMI gain at week 12.CONCLUSION: In youth with FEP, quetiapine-ER was associated with significantly greater weight gain and adverse changes in metabolic outcomes than aripiprazole. Early weight gain must be addressed and family lifestyle factors taken into consideration when treating youth with antipsychotics.

U2 - 10.1016/j.jaac.2019.01.015

DO - 10.1016/j.jaac.2019.01.015

M3 - Journal article

C2 - 30858012

VL - 58

SP - 1062

EP - 1078

JO - American Academy of Child and Adolescent Psychiatry. Journal

JF - American Academy of Child and Adolescent Psychiatry. Journal

SN - 0890-8567

IS - 11

ER -