Body Weight and Metabolic Adverse Effects of Asenapine, Iloperidone, Lurasidone and Paliperidone in the Treatment of Schizophrenia and Bipolar Disorder

Abstract

Background: The introduction of second-generation antipsychotics (SGAs) over the past 2 decades generated considerable optimism that better anti-psychotic treatments for schizophrenia and bipolar disorder were possible. SGAs offer several tolerability benefits over first-generation antipsychotics (FGAs), particularly with respect to extrapyramidal symptoms. However, SGAs can induce serious metabolic dysregulations, especially in drug-naive, first-episode, and child and adolescent populations, with olanzapine and clozapine having the highest propensity to cause these abnormalities. In this context, newer SGAs were developed to further improve the adverse effect burden of available agents. However, until now, the metabolic risk profile of the newly approved SGAs — asenapine, iloperidone, lurasidone and paliperidone (paliperidone extended release and paliperidone palmitate) — has not been compared.