Consider switching olanzapine to aripiprazole or quetiapine in case of weight gain or metabolic problems.
A Cochrane review [Abstract] 1 included 4 studies with a total of 636 subjects with schizophrenia. Three studies had duration of 26 weeks or less. Being overweight or obese and/or having metabolic complications were inclusion criteria in 3 studies. Mean weight loss was 1.94 kg when switched from olanzapine to aripiprazole or quetiapine (CI -3.9 to 0.08; 2 RCT, n = 287). BMI also decreased when switched from olanzapine to quetiapine (MD -0.52, CI -1.26 to 0.22; 1 RCT, n = 129) and aripiprazole (RR 0.28, CI 0.13 to 0.57; 1 RCT, n = 173). Fasting blood glucose decreased significantly when switched from olanzapine to aripiprazole or quetiapine (MD -2.53, CI -2.94 to -2.11; 2 RCT, n = 280). One RCT also showed a favourable lipid profile when switched to aripiprazole but these measures were reported as percentage changes, rather than means with standard deviation. People are less likely to leave the study early if they remain on olanzapine compared to switching to quetiapine or aripiprazole. There was no significant difference in outcomes of mental state, global state, and adverse events between the groups switching medications and those remaining on previous medication. Three different switching strategies were compared and no strategy was found to be superior to the others for outcomes of weight gain, mental state and global state.
Comment: The quality of the evidence is downgraded by study quality (inadequate allocation concealment, more than 20% loss to follow-up) and imprecise results (limited study size for each comparison).
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