Impact of Lurasidone on Metabolic Functions Compared to Other Antipsychotics – Results of a Large Meta-Analysis
Antipsychotic therapy is associated with varying degrees of metabolic abnormalities in parameters of weight, lipid metabolism, and glucose metabolism. The presence of metabolic syndrome or isolated disorders of glucose and lipid metabolism further increases the risk of morbidity and mortality in patients with schizophrenia compared to the general population. Lurasidone is an antipsychotic indicated for the acute and maintenance treatment of schizophrenia. The advantage of this drug is its low risk of metabolic side effects, which has been confirmed in a recent large meta-analysis of clinical studies.
Introduction
Approximately one-third of patients with schizophrenia exhibit metabolic syndrome, with prevalence rising to 69% in patients with chronic conditions. Individuals with schizophrenia show a 3–5 times higher prevalence of obesity, type 2 diabetes, and hypercholesterolemia compared to the general population. Patients with schizophrenia therefore have twice the likelihood of being diagnosed with cardiovascular disease and dying from its consequences.
Until recently, there was no published study that evaluated the impact of individual antipsychotics on metabolic parameters in patients with schizophrenia using network meta-analysis methods. However, in 2020, a large meta-analysis was published in the journal The Lancet Psychiatry, aiming to compare the effects of 18 antipsychotics on metabolic parameters. One of the studied antipsychotics was lurasidone, which belongs to the group of serotonin and dopamine antagonists (SDA) and is indicated for the acute and maintenance treatment of schizophrenia in adults and adolescents aged 13 years and older. Previous studies have observed a favorable metabolic profile for lurasidone.
Meta-Analysis and Its Findings
The meta-analysis included randomized double-blind controlled clinical trials comparing the effect of 18 antipsychotics and placebo in the acute treatment of schizophrenia. The aim of the meta-analysis was to assess the impact of antipsychotics on weight gain, BMI value, and parameters of lipid (LDL-c, HDL-c, TG) and glucose metabolism. The analysis included 100 studies with a total of 25,952 patients (21,124 treated with antipsychotics, 4,828 on placebo).
According to the results of this meta-analysis, lurasidone, along with aripiprazole, brexpiprazole, cariprazine, and ziprasidone, was among the antipsychotics with the most favorable metabolic profiles. On the other hand, olanzapine and clozapine had the worst metabolic profiles in the meta-analysis. Patients treated with lurasidone did not show significant weight gain, and their BMI value increased only slightly. There were no statistically significant changes in total cholesterol, LDL-c, HDL-c, and triglyceride levels. In terms of fasting glucose levels, patients treated with lurasidone exhibited the highest statistically significant reduction in plasma glucose levels compared to all other antipsychotics (-0.29 mmol/l; 95% confidence interval [CI] -0.55 to -0.03).
Conclusion
The results of the large meta-analysis indicate that lurasidone is among the antipsychotics with the most favorable metabolic profiles. Patients treated with lurasidone did not show weight gain or significant changes in lipid metabolism. In terms of fasting glucose, patients treated with lurasidone exhibited the largest statistically significant reduction in values compared to other antipsychotics.
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Sources:
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