Antipsychotic polypharmacy and metabolic syndrome in schizophrenia: a review of systematic reviews

Sharea Ijaz,Sarah Sullivan,Simon Davies,Blanca Bolea,Jelena Savović,Alison Richards,Paul Moran

doi:10.1186/s12888-018-1848-y

Abstract

BackgroundThere is conflicting evidence on the association between antipsychotic polypharmacy and metabolic syndrome in schizophrenia. We conducted a review of published systematic reviews to evaluate evidence on the association between metabolic syndrome (diabetes, hypertension, and hyperlipidaemia) and exposure to antipsychotic polypharmacy in schizophrenia.MethodsWe searched five electronic databases, complemented by reference screening, to find systematic reviews that investigated the association of antipsychotic polypharmacy in schizophrenia with hypertension, diabetes, or hyperlipidaemia. Selection of reviews, data extraction and review quality were conducted independently by two people and disagreements resolved by discussion. Results were synthesised narratively.ResultsWe included 12 systematic reviews, which reported heterogeneous results, mostly with narrative syntheses and without pooled data. The evidence was rated as low quality. There was some indication of a possible protective effect of drug combinations including aripiprazole for diabetes and hyperlipidaemias, compared to other combinations and/or monotherapy. Only one review reported the association between APP and hypertension. The most frequently reported combinations of medication included clozapine, possibly representing a sample of patients with treatment resistant illness. No included review reported results separately by setting (primary or secondary care).ConclusionsFurther robust studies are needed to elucidate the possible protective effect of aripiprazole. Long-term prospective studies are required for accurate appraisal of diabetes risk, hypertension and hyperlipidaemia in patients exposed to antipsychotic polypharmacy.

Highlights

There is conflicting evidence on the association between antipsychotic polypharmacy and metabolic syndrome in schizophrenia
These drugs can be divided in two main classes: first generation antipsychotics (FGA or typical antipsychotics) such as haloperidol and second-generation antipsychotics (SGA or atypical) such as risperidone, olanzapine and quetiapine
Inclusion criteria for reviews We included systematic reviews that reported an investigation of the association between Antipsychotic polypharmacy (APP) and metabolic syndrome in adults with schizophrenia treated in any setting

Summary

Introduction

There is conflicting evidence on the association between antipsychotic polypharmacy and metabolic syndrome in schizophrenia. We conducted a review of published systematic reviews to evaluate evidence on the association between metabolic syndrome (diabetes, hypertension, and hyperlipidaemia) and exposure to antipsychotic polypharmacy in schizophrenia. Antipsychotic medication is the first line treatment for schizophrenia [7, 8]. Antipsychotic drugs are effective for the treatment of the core symptoms of schizophrenia, such as auditory hallucinations and delusions. These drugs can be divided in two main classes: first generation antipsychotics (FGA or typical antipsychotics) such as haloperidol and second-generation antipsychotics (SGA or atypical) such as risperidone, olanzapine and quetiapine.

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Conclusion