In children taking antipsychotic medications for first-episode psychosis, quetiapine-extended release was associated with increased negative body composition and metabolic parameters when compared with aripiprazole, according to a study published in the Journal of the American Academy of Child and Adolescent Psychiatry.

Researchers of the Tolerability and Efficacy of Antipsychotics in Children and Adolescents With Psychosis trial (NCT01119014) describe the clinical meaningfulness of cardiometabolic adverse events for children with first-episode psychosis taking either quetiapine-extended release or aripiprazole. The 12-week, randomized, double-blind study included children between the ages of 12 and 17 who were diagnosed with psychosis, according to the International Classification of Diseases Manual, 10th edition. At baseline, physical assessments, fasting blood analysis, lifestyle factors, and demographics were collected. Follow-up data were collected at weeks 2, 4, and 12.

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Of the 113 children included in this trial, 30.1% were boys, the mean age was 15.7 years old, 55 were randomly assigned to the quetiapine-extended release cohort, and 58 were randomly assigned to the aripiprazole cohort. Patients in the quetiapine-extended release cohort had a significant increase in body weight of 1.37 kg at week 2, 2.24 kg at week 4, and 4.88 kg at week 12 (P <.0001, for all), significant increase in body mass index z-scores of 0.14 at week 2, 0.24 at week 4, and 0.43 at week 12 (P <.0001, for all), and a significant increase in waist circumference z-score of 0.53 at week 2, 0.57 at week 4, and 0.97 at week 12 (P <.0001, for all). Patients in the aripiprazole cohort had only a significant increase in body weight of 1.97 kg at week 12 (P <.0001). Patients in the quetiapine-extended release cohort had a significant increase in levels of insulin, homeostatic model assessment of insulin resistance, cholesterol, nonhigh density lipoprotein cholesterol, triglycerides, and low-density lipoprotein cholesterol. Patients in the aripiprazole cohort did not have significant changes in fasting blood analysis. Weight gain over the first 2 weeks, a first-degree relative with obesity, or a first-degree relative with type 2 diabetes was associated with larger changes in the child’s weight from baseline to week 12.

Limitations of this study include laboratory differences between sites, unknown factors of diet and exercise, inability to assess all measurements at a consistent time and environment, and the ability of children to take other medication.

The researchers of the study concluded “patients treated with quetiapine-[extended release] developed significantly more weight gain and metabolic disturbances compared to patients treated with aripiprazole. These differences emerged early, are clinically relevant and should inform treatment choice for youth with [early onset psychosis], especially given the fact that in the [Tolerability and Efficacy of Antipsychotics in Children and Adolescents With Psychosis] trial quetiapine-[extended release] and aripiprazole were equally effective for improving psychopathology.”

Several authors report multiple associations with pharmaceutical companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Jensen KG, Correll CU, Rudå D, et al. Cardiometabolic adverse effects and its predictors in children and adolescents with first-episode psychosis during treatment with quetiapine-extended release versus aripiprazole: 12-week results from the tolerance and effect of antipsychotics in children and adolescents with psychosis (TEA) trial [published online March 8, 2019]. J Am Acad Child Adolesc Psychiatry. doi: 10.1016/j.jaac.2019.01.015