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Review: metabolic side effects of second-generation antipsychotics

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To what extent do second-generation antipsychotics (SGAs) cause metabolic side effects?


Primary: weight change. Secondary: changes in glucose and cholesterol levels.



Systematic review and meta-analysis.

Data sources

Cochrane schizophrenia group register (comprising literature from BIOSIS< CINAHL, EMBASE, LILACS, MEDLINE, PSYINDEX, PsychINFO, RUSSMED, Sociofile, dissertation abstracts, conference proceedings and findings from hand searching) up to May 2007. Supplementary search of MEDLINE and EMBASE to January 2009.

Study selection and analysis

The review focused on randomised blinded head-to-head trials of specified orally administered SGAs. Manufacturers of these drugs (amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, risperidone, sertindole, ziprasidone and zotepine) were also contacted for further trials. Data extraction was undertaken by at least three reviewers. Meta-analysis was used to pool estimates of effect, and meta-regression was used to examine the effects of study duration, study sponsorship, gender, ethnicity and a variety of baseline physiological measures on differences between groups.

Main results

Forty-eight relevant trials were included; 6 of amisulpride, 5 of aripiprazole, 11 of clozapine, 37 of olanzapine, 11 of quetiapine, 28 of risperidone, 1 of sertindole and 6 of ziprasidone. …

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  • Sources of funding Technische Universität München, the German Federal Ministry of Education and Research, the National Institute of Mental Health, Advanced Center for Intervention and Services Research Center, the Maryland Psychiatric Research Center.


  • Competing interests EJ has been reimbursed by Eli Lilly and Janssen Cilag for attending conferences. EJ has also received honoraria for lectures given in meetings arranged by Eli Lilly, Astra Zeneca, and Bristol-Myers-Squibb, as well as for contributing scientifically to a brochure developed by Eli Lilly.