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Metabolic Risk Status and Second-Generation Antipsychotic Drug Selection: A Retrospective Study of Commercially Insured Patients

Morrato, Elaine H. DrPH, MPH*†‡; Cuffel, Brian PhD§; Newcomer, John W. MD∥¶#; Lombardo, Ilise MD§; Kamat, Siddhesh MS**; Barron, John PharmD**

Journal of Clinical Psychopharmacology: February 2009 - Volume 29 - Issue 1 - p 26-32
doi: 10.1097/JCP.0b013e31819294cb
Original Contributions

Background: Routine metabolic screening and consideration of patient metabolic status in the choice of a second-generation antipsychotic (SGA) medication are recommended. This study evaluated the association between abnormal blood glucose and lipid values and SGA prescribing patterns.

Materials and Methods: A retrospective cohort study using administrative data from 2 managed care plans in the United States evaluated 7904 adults initiating SGA therapy between 2001 and 2004. Baseline serum glucose, total cholesterol, and triglyceride values were available for 989 patients (12.5%), and follow-up assessments were done in 699 patients (8.8%). Abnormal values were defined as the following: total cholesterol, 200 mg/dL or higher; triglycerides, 200 mg/dL or higher; and glucose, 126 mg/dL or higher. The likelihood of abnormal laboratory values being associated with selection of a lower metabolic risk SGA drug (aripiprazole or ziprasidone) and with switching decisions was assessed using multivariate logistic regression models.

Results: Thirteen percent of the patients had glucose and lipid tests within 6 months of starting SGA therapy. The likelihood of starting a patient on an SGA drug with lower metabolic risk (ziprasidone: odds ratio, 3.26; 95% confidence interval, 1.25-8.47; aripiprazole: odds ratio, 2.13; 95% confidence interval, 0.77-5.88) was higher if the patient had elevated glucose values but was not associated with elevated cholesterol or triglyceride values or if the patient had preexisting diabetes or dyslipidemia. Abnormal glucose and lipid values were not associated with switching SGA medications in the first 6 months of therapy. Among patients who did switch SGA medications, elevated glucose and lipid values were not associated with a greater likelihood of switching to aripiprazole or ziprasidone.

Conclusions: Low rates of recommended monitoring were observed. Abnormal metabolic parameters among those who were tested were not consistently associated with the selection of an SGA drug with lower metabolic risk.

From the *Department of Pediatrics, School of Medicine, and †Department of Health Systems, Management and Policy Colorado School of Public Health, University of Colorado Denver, Aurora, CO; ‡Department of Clinical Pharmacy, School of Pharmacy, University of Colorado Denver, Aurora, CO; §Pfizer Inc, New York, NY; Departments of ∥Psychiatry, ¶Psychology, and #Medicine, Washington University School of Medicine, St Louis, MO; and **HealthCore Inc, Wilmington, DE.

Received May 20, 2008; accepted after revision October 24, 2008.

Reprints: Elaine H. Morrato, DrPH, MPH, University of Colorado Denver, Colorado Health Outcomes Program, Mailstop F443, PO Box 6508, Aurora, CO 80045-0508 (e-mail:

This study was presented in part at the 160th Annual Meeting of the American Psychiatric Association, San Diego, CA, May 19-24, 2007.

This study was supported by funding from Pfizer, Inc.

© 2009 Lippincott Williams & Wilkins, Inc.