BMC psychiatry · 2025
Assessing the metabolic impact of aripiprazole versus risperidone in the treatment of schizophrenia: a randomized double-blind controlled clinical trial.
СтатьяРандомизированное исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Rahimi Darehbagh Ramyar, Ghanizadeh Ahmad, Seyedoshohadaei Seyedeh Asrin
Аннотация
BACKGROUND: Antipsychotic-induced metabolic side effects remain a major challenge in schizophrenia management, contributing to cardiovascular morbidity and reduced life expectancy. Aripiprazole and risperidone are among the most widely prescribed second-generation antipsychotics (SGAs), yet their differential metabolic effects, particularly in real-world patient populations extending beyond first-episode psychosis, require further clarification.
OBJECTIVE: To compare the short-term metabolic impact of aripiprazole versus risperidone in patients with schizophrenia, with specific attention to changes in body mass index (BMI), lipid profiles, appetite regulation, and other cardiometabolic parameters.
METHODS: In this 7-week, randomized, double-blind, controlled trial, 60 patients with schizophrenia were allocated to aripiprazole (5-30 mg/day) or risperidone (2-10 mg/day). Eligible patients were either antipsychotic-naïve or had undergone at least a one-week washout period. Primary outcome was change in BMI. Secondary outcomes included waist circumference, blood pressure, fasting lipids, treatment-emergent adverse events (TEAEs), and changes in appetite. Compliance was assessed via pill counts and structured patient interviews. Missing data were handled using generalized estimating equations (GEE).
RESULTS: Fifty-seven patients completed the study. Risperidone was associated with significantly greater BMI increases than aripiprazole (mean change: +1.1 ± 0.3 vs. +0.4 ± 0.2; p < 0.001). Trends favored aripiprazole for triglycerides (+ 7.3 vs. +28.1 mg/dL) and total cholesterol (+ 0.1 vs. +5.1 mg/dL), though differences did not reach statistical significance. Appetite effects diverged sharply: decreased appetite occurred more often with aripiprazole (60.7% vs. 20.7%; p = 0.002), whereas increased appetite was more common with risperidone (55.2% vs. 39.3%). Baseline demographics, illness duration, and Positive and Negative Syndrome Scale (PANSS) scores were comparable across groups, and both treatments significantly reduced PANSS scores over time.
CONCLUSIONS: Aripiprazole demonstrated a more favorable short-term metabolic profile compared to risperidone, with significantly less weight gain and appetite suppression as a potential mechanistic correlate. Appetite changes may serve as an early, clinically accessible predictor of long-term metabolic trajectories. These findings support integrating appetite monitoring into routine clinical practice and highlight the need to individualize antipsychotic selection based on metabolic risk.
TRIAL REGISTRATION: IRCT201305233930N26.
OBJECTIVE: To compare the short-term metabolic impact of aripiprazole versus risperidone in patients with schizophrenia, with specific attention to changes in body mass index (BMI), lipid profiles, appetite regulation, and other cardiometabolic parameters.
METHODS: In this 7-week, randomized, double-blind, controlled trial, 60 patients with schizophrenia were allocated to aripiprazole (5-30 mg/day) or risperidone (2-10 mg/day). Eligible patients were either antipsychotic-naïve or had undergone at least a one-week washout period. Primary outcome was change in BMI. Secondary outcomes included waist circumference, blood pressure, fasting lipids, treatment-emergent adverse events (TEAEs), and changes in appetite. Compliance was assessed via pill counts and structured patient interviews. Missing data were handled using generalized estimating equations (GEE).
RESULTS: Fifty-seven patients completed the study. Risperidone was associated with significantly greater BMI increases than aripiprazole (mean change: +1.1 ± 0.3 vs. +0.4 ± 0.2; p < 0.001). Trends favored aripiprazole for triglycerides (+ 7.3 vs. +28.1 mg/dL) and total cholesterol (+ 0.1 vs. +5.1 mg/dL), though differences did not reach statistical significance. Appetite effects diverged sharply: decreased appetite occurred more often with aripiprazole (60.7% vs. 20.7%; p = 0.002), whereas increased appetite was more common with risperidone (55.2% vs. 39.3%). Baseline demographics, illness duration, and Positive and Negative Syndrome Scale (PANSS) scores were comparable across groups, and both treatments significantly reduced PANSS scores over time.
CONCLUSIONS: Aripiprazole demonstrated a more favorable short-term metabolic profile compared to risperidone, with significantly less weight gain and appetite suppression as a potential mechanistic correlate. Appetite changes may serve as an early, clinically accessible predictor of long-term metabolic trajectories. These findings support integrating appetite monitoring into routine clinical practice and highlight the need to individualize antipsychotic selection based on metabolic risk.
TRIAL REGISTRATION: IRCT201305233930N26.