A Randomized Trial Examining the Effectiveness of Switching From Olanzapine, Quetiapine, or Risperidone to Aripiprazole to Reduce Metabolic Risk: Comparison of Antipsychotics for Metabolic Problems (CAMP)
Publication: American Journal of Psychiatry
Abstract
Objective:
The authors conducted a multisite randomized controlled trial examining the strategy of switching from olanzapine, quetiapine, or risperidone to aripiprazole to ameliorate metabolic risk factors for cardiovascular disease.
Method:
Patients with schizophrenia or schizoaffective disorder with a body mass index ≥27 and non-high-density lipoprotein (non-HDL) cholesterol ≥130 mg/dl who were on a stable treatment dosage of olanzapine, quetiapine, or risperidone were randomly assigned to switch to ari-piprazole (N=109) for 24 weeks or stay on their current medication (N=106). All participants were enrolled in a behaviorally oriented diet and exercise program. Clinical raters were blinded to treatment assignment. The primary and key secondary outcomes were change in non-HDL cholesterol and efficacy failure, respectively.
Results:
The prespecified primary analysis included 89 switchers and 98 stayers who had at least one postbaseline non-HDL cholesterol measurement. The least squares mean estimates of non-HDL cholesterol decreased more for the switch group than for the stay group (–20.2 mg/dl and –10.8 mg/dl, respectively). Switching was associated with larger weight reductions (least squares mean=2.9 kg) and a net reduction of serum triglycerides of 32.7 mg/dl. Twenty-two switchers (20.6%) and 18 stayers (17.0%) experienced protocol-defined efficacy failure. Forty-seven switchers (43.9%) and 26 stayers (24.5%) discontinued the assigned antipsychotic medication before 24 weeks.
Conclusions:
Switching to aripiprazole led to improvement of non-HDL cholesterol levels and other metabolic parameters. Rates of efficacy failure were similar between groups, but switching to aripiprazole was associated with a higher rate of treatment discontinuation. In the context of close clinical monitoring, switching from an antipsychotic with high metabolic risk to one with lower risk to improve metabolic parameters is an effective strategy.
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History
Received: 8 November 2010
Revision received: 17 February 2011
Revision received: 12 April 2011
Accepted: 29 April 2011
Published online: 1 September 2011
Published in print: September 2011
Authors
Funding Information
Within the last 3 years Dr. Stroup has received consulting fees from Janssen and Lilly. Dr. Nussbaum and Ms. Ring report no financial relationships with commercial interests. Dr. McEvoy receives speaking honoraria from Eli Lilly; consultation and honorarium fees for educational lecture for staff from Hoffman LaRoche; advisory fees from Merck; honoraria for speaking and a research grant from Sunovion; and a research grant from GlaxoSmithKline. Dr. Hamer has received advisory or consulting fees, has served on a data and safety monitoring board and an advisory board, or was involved in a contract between the University of North Carolina and the following: Abbott, Acadia, Allergan, Alpharma, AstraZeneca, Cenerx, Corcept, Eli Lilly, EnabledMD, Epix, Johnson and Johnson, Novartis, Pfizer, PureTechVentures, Schwartz, Sanofi-Aventis, Takeda, and Wyeth. Dr. Hamer has served as an expert witness in lawsuits involving Forest, Lundbeck, Sun, Caraco, Teva, Barr, Mylan, Eurand, Cephalon, and Anesta. Dr. LaVange has served on a data and safety monitoring board for MAP Pharmaceuticals, consulted for Parion Sciences, received an honorarium from GlaxoSmithKline, owns stock options from Inspire Pharmaceuticals, and has received research funding from Pfizer and Merck. Dr. Swartz has received research support from Eli Lilly and consulting fees from Novartis. Dr. Rosenheck has received research support from Janssen Pharmaceutica and Wyeth Pharmaceuticals and has consulted to Roche Pharmaceuticals. He has also been a consultant for and is a testifying expert in Jones ex rel. the State of Texas v. Janssen Phamaceutica et al. Dr. Perkins has been a consultant and speaker for Eli Lilly and a consultant for Sunovion. Dr. Lieberman serves on the advisory boards of Bioline, GlaxoSmithKline, Intracellular Therapies, Eli Lilly, Pierre Fabre, and Psychogenics. He does not receive financial compensation or salary support for his participation as an advisor. He receives grant support from Allon, GlaxoSmithKline, Merck, Novartis, Pfizer, Sepracor, and Targacept, and he holds a patent from Repligen.Supported by a grant from the Foundation for NIH (FNIH) and by a contract from NIMH (N01 MH900001). Bristol-Myers Squibb provided aripiprazole and funds to FNIH in support of the study. Bristol-Myers Squibb was not involved in the conduct of the study, data analysis, or the preparation of this manuscript.
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