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Metabolic Effects of Paliperidone Extended Release Versus Oral Olanzapine in Patients With Schizophrenia: A Prospective, Randomized, Controlled Trial

Schreiner, Andreas MD*; Niehaus, Dana MD; Shuriquie, Nasser Aldien MD; Aadamsoo, Kaire MD§; Korcsog, Peter MD; Salinas, Rolando MD; Theodoropoulou, Pitsa MD#; Fernández, Lorena García MD**; Üçok, Alp MD††; Tessier, Christophe MD‡‡; Bergmans, Paul MSc§§; Hoeben, Dagmar PhD∥∥

Journal of Clinical Psychopharmacology: August 2012 - Volume 32 - Issue 4 - p 449–457
doi: 10.1097/JCP.0b013e31825cccad
Original Contributions

Abstract: Metabolic effects are generally more pronounced with second-generation than first-generation antipsychotics. This study was designed to compare long-term metabolic effects and efficacy of paliperidone extended release (ER) with those of oral olanzapine in patients with schizophrenia. In this 6-month, multicenter, prospective, randomized, controlled, open-label, parallel-group study, adults with schizophrenia were treated with paliperidone ER (6–9 mg/d; n = 239) or oral olanzapine (10–15 mg/d; n = 220). The primary outcome was mean change in the ratio of serum triglyceride level to high-density lipoprotein level (TG/HDL), a marker of insulin resistance. Other outcome measures included the Positive and Negative Syndrome Scale scores, measures of lipid and glucose metabolism, and body weight. Significant improvements in psychotic symptoms were observed with both treatments (P < 0.0001). The TG/HDL ratio was significantly higher at end point versus baseline with olanzapine compared with that of paliperidone ER. Mean end point change in TG/HDL ratio was 0.097 ± 2.72 for olanzapine (P < 0.0001, reflecting worsening), with no significant change for paliperidone ER (−0.17 ± 2.51). Newly diagnosed impairment in TG and metabolic syndrome was more common with olanzapine (P < 0.05). Insulin resistance, as measured by the homeostasis model assessment of insulin resistance, worsened significantly with olanzapine (P = 0.0003), but not with paliperidone ER. Glucose sensitivity for insulin worsened significantly with olanzapine (P < 0.03), with no significant changes for paliperidone ER. End point increase in body weight was significantly higher with olanzapine than paliperidone ER (3.8 vs 1.2 kg; P = 0.0013). In summary, both paliperidone ER and olanzapine effectively treated schizophrenia; however, undesirable metabolic effects were significantly greater with olanzapine.

From the *Medical Affairs EMEA, Janssen-Cilag GmbH, Neuss, Germany; †Flexivest Fourteen Research Centre, Cape Town, South Africa; ‡Al-Rashid Hospital, Abu Nsair, Amman, Jordan; §Clinic of Psychiatry, North Estonian Regional Hospital, Tallin, Estonia; ∥Department of Psychiatry, General Hospital Rimavska Sobota, Rimavska Sobota, Slovakia; ¶Instituto para la Prevención de las Enfermedades Mentales, Buenos Aires, Argentina; #Department of Psychiatry, Sismanoglio Hospital, Maroussi-Athens, Greece; **Servicio de Psiquiatría, Hospital Clínico Universitario San Juan Alicante, San Juan Alicante, Spain; ††Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul, Turkey; ‡‡Medical Affairs EMEA, Janssen-Cilag SAS, Paris, France; §§Janssen-Cilag BV, Tilburg, Netherlands; and ∥∥Medical Affairs EMEA, Janssen Pharmaceutica NV, Beerse, Belgium.

Received December 1, 2010; accepted after revision December 13, 2011.

Reprints: Andreas Schreiner, MD, Medical Affairs EMEA, Janssen-Cilag GmbH, Johnson & Johnson Platz 1, 41470 Neuss, Germany (e-mail: aschrein@its.jnj.com).

This study and the writing/editorial support were funded by Janssen Pharmaceutical Companies of Johnson & Johnson in EMEA. The writing/editorial support was provided by Tam Vo and team from Excerpta Medica.

© 2012 Lippincott Williams & Wilkins, Inc.