This retrospective chart review evaluates the long term metabolic effects of the newer second generation antipsychotics (SGAs) in a real-world patient population.

While extensive research has been conducted comparing the metabolic profiles of older second-generation antipsychotic drugs, minimal data exists comparing the long-term metabolic effects of SGAs approved in the last ten years. The findings are expected to supplement pivotal clinical trials for brexpiprazole (Rexulti), lurasidone (Latuda), asenapine (Saphris), cariprazine (Vraylar), and iloperidone (Fanapt) in characterizing their metabolic effects and assisting clinicians in their decision to prescribe these medications for their patients in terms of metabolic outcomes using real-world clinical data.

A retrospective chart review of patients treated with brexpiprazole, lurasidone, asenapine, cariprazine, or iloperidone for a minimum of six weeks at a psychiatry clinic was conducted. Patients treated with olanzapine, an older second generation antipsychotic, were included as a comparator population. Metabolic parameters of interest were collected if available at approximately 6 weeks, 12 weeks, and up to 12 months (≤1 year) after treatment initiation.

Of the six different second generation antipsychotics, there were statistically significant increases in patients’ average weight for 12 weeks and ≤1 year with brexpiprazole (2.48 lbs, p=0.02; 5.97 lbs, p=0.01) and iloperidone (4.54 lbs, p<0.01; 5.13 lbs, p=0.02). As expected from prior literature, olanzapine had significant weight gain at 6 weeks, 12 weeks, and ≤1 year. Brexpiprazole, iloperidone, and olanzapine resulted in a significant increase in BMI at various visits, up to a 1.65 kg/m2 average increase in patients taking olanzapine at ≤1 year.

Although some weight gain was seen with the newer SGAs, all demonstrated a more favorable metabolic profile compared to olanzapine. Regular monitoring of weight and other metabolic parameters remains an important component of the care plan for patients being treated with these medications.