NEW YORK (Reuters Health) – Elderly patients with Alzheimer’s disease treated with second-generation antipsychotics should be monitored closely for weight gain and dyslipidemia, according to an analysis of data from the Clinical Antipsychotic Trials of Intervention Effectiveness–Alzheimer’s Disease (CATIE-AD).

The 36-week randomized, double-blind, placebo-controlled trial included 421 outpatients with Alzheimer’s disease (mean age 78 years; 56% female) being treated for delusions and aggression. Seventy-two patients had no exposure to the study drugs, while the remaining subjects were assigned to treatment with olanzapine, quetiapine, and risperidone; they could switch antipsychotic medication during the trial.

Female subjects gained on average 0.14 pounds per week (p = 0.006), and an increase in body mass index of 0.03 kg/m² per week, while changes in weight and BMI among males were nonsignificant, Dr. Lon S. Schneider, at the University of Southern California, Los Angeles, and associates report in an advance edition of the American Journal of Psychiatry published online on April 15.

The duration of antipsychotic use was significantly associated with weight gain among women. “The prevalence of significant weight gain was 10%, 17%, and 20% among patients with less than 12 weeks, 12-24 weeks, and greater than 24 weeks of use compared to 7% with no use,” Dr. Schneider’s team observes.

The effect on weight was significant for olanzapine (p = 0.032) and quetiapine (p = 0.019), and approached significance for risperidone (p = 0.07). Olanzapine was also significantly associated with increased waist circumference and decreased HDL cholesterol.

The metabolic changes associated with second-generation antipsychotic use were of similar magnitude to that observed in younger people with schizophrenia, the team notes.

The worsening cardiometabolic risks in Alzheimer’s patients are “particularly concerning,” they add, and likely explain the increased mortality risk associated with these drugs.

Results from a previous analysis of the CATIE-AD data indicated that the drugs did not improve patients’ function, care needs, or quality of life.

Reference:
Am J Psychiatry 2009.