Comparison of metabolic effects of aripiprazole, quetiapine and ziprasidone after 12 weeks of treatment in first treated episode of psychosis

This randomized open-label study compared the incidence of metabolic side effects of aripiprazole, ziprasidone and quetiapine in a population of medication-naïve first-episode psychosis patients.A total of 202 subjects were enrolled. Body weight, body mass index, leptin, fasting lipids and fasting glycaemic parameters were measured at baseline and at 3. months follow-up. A hundred and sixty-six patients completed the follow-up and were included in the analyses. A high proportion of patients experienced a significant weight increase (>. 7% of their baseline weight): 23% ziprasidone (. n=. 12), 32% with quetiapine (. n=. 16) and 45% with aripiprazole (. n=. 31). Patients treated with aripiprazole gained significantly more weight than the patients in the ziprasidone group (1.2. kg [SD. =. 4.1] versus 4.3. kg [SD. =. 4.8], respectively). The increase in leptin levels was greater in women treated with aripiprazole than in those treated with ziprasidone (. p=. 0.030). Mean prolactin levels significantly increased in patients treated with quetiapine and ziprasidone but not in those treated with aripiprazole.Patients treated with quetiapine and aripiprazole showed a significant increase in total cholesterol and LDL-cholesterol plasma levels. Quetiapine-treated patients resulted in a higher increase in LDL-cholesterol than patients treated with ziprasidone (. p=. 0.021). No other significant differences between groups were found. No significant changes in glycaemic parameters were observed.Our results suggest that ziprasidone has a lower liability for inducing weight gain and lipid abnormalities than aripiprazole or quetiapine.