A randomized trial examining the effectiveness of switching from olanzapine, quetiapine, or risperidone to aripiprazole to reduce metabolic risk: Comparison of Antipsychotics for Metabolic Problems (CAMP)

T. Scott Stroup, Joseph Patrick McEvoy, Kimberly D. Ring, Robert H. Hamer, Lisa M. LaVange, Marvin S. Swartz, Robert A. Rosenheck, Diana O. Perkins, Abraham M. Nussbaum, Jeffrey A. Lieberman

Research output: Contribution to journalArticle

109 Citations (Scopus)

Abstract

Objective: The authors conducted a multisite randomized controlled trial examining the strategy of switching from olanzapine, quetiapine, or risperidone to aripiprazole to ameliorate metabolic risk factors for cardiovascular disease. Method : Patients with schizophrenia or schizoaffective disorder with a body mass index ≥27 and non-high-density lipoprotein (non-HDL) cholesterol ≥130 mg/dl who were on a stable treatment dosage of olanzapine, quetiapine, or risperidone were randomly assigned to switch to aripiprazole (N=109) for 24 weeks or stay on their current medication (N=106). All participants were enrolled in a behaviorally oriented diet and exercise program. Clinical raters were blinded to treatment assignment. The primary and key secondary outcomes were change in non-HDL cholesterol and efficacy failure, respectively. Results : The prespecified primary analysis included 89 switchers and 98 stayers who had at least one postbaseline non-HDL cholesterol measurement. The least squares mean estimates of non-HDL cholesterol decreased more for the switch group than for the stay group (-20.2 mg/ dl and -10.8 mg/dl, respectively). Switching was associated with larger weight reductions (least squares mean=2.9 kg) and a net reduction of serum triglycerides of 32.7 mg/dl. Twenty-two switchers (20.6%) and 18 stayers (17.0%) experienced protocol- defined efficacy failure. Forty-seven switchers (43.9%) and 26 stayers (24.5%) discontinued the assigned antipsychotic medication before 24 weeks. Conclusion : Switching to aripiprazole led to improvement of non-HDL cholesterol levels and other metabolic parameters. Rates of efficacy failure were similar between groups, but switching to aripiprazole was associated with a higher rate of treatment discontinuation. In the context of close clinical monitoring, switching from an antipsychotic with high metabolic risk to one with lower risk to improve metabolic parameters is an effective strategy.

Original languageEnglish (US)
Pages (from-to)947-956
Number of pages10
JournalAmerican Journal of Psychiatry
Volume168
Issue number9
DOIs
StatePublished - Sep 1 2011

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olanzapine
Risperidone
Antipsychotic Agents
Least-Squares Analysis
Psychotic Disorders
Weight Loss
Schizophrenia
Triglycerides
Body Mass Index
Cardiovascular Diseases
Therapeutics
Randomized Controlled Trials
Aripiprazole
lipoprotein cholesterol
Quetiapine Fumarate
Exercise
Diet

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

A randomized trial examining the effectiveness of switching from olanzapine, quetiapine, or risperidone to aripiprazole to reduce metabolic risk : Comparison of Antipsychotics for Metabolic Problems (CAMP). / Stroup, T. Scott; McEvoy, Joseph Patrick; Ring, Kimberly D.; Hamer, Robert H.; LaVange, Lisa M.; Swartz, Marvin S.; Rosenheck, Robert A.; Perkins, Diana O.; Nussbaum, Abraham M.; Lieberman, Jeffrey A.

In: American Journal of Psychiatry, Vol. 168, No. 9, 01.09.2011, p. 947-956.

Research output: Contribution to journalArticle

Stroup, T. Scott ; McEvoy, Joseph Patrick ; Ring, Kimberly D. ; Hamer, Robert H. ; LaVange, Lisa M. ; Swartz, Marvin S. ; Rosenheck, Robert A. ; Perkins, Diana O. ; Nussbaum, Abraham M. ; Lieberman, Jeffrey A. / A randomized trial examining the effectiveness of switching from olanzapine, quetiapine, or risperidone to aripiprazole to reduce metabolic risk : Comparison of Antipsychotics for Metabolic Problems (CAMP). In: American Journal of Psychiatry. 2011 ; Vol. 168, No. 9. pp. 947-956.
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abstract = "Objective: The authors conducted a multisite randomized controlled trial examining the strategy of switching from olanzapine, quetiapine, or risperidone to aripiprazole to ameliorate metabolic risk factors for cardiovascular disease. Method : Patients with schizophrenia or schizoaffective disorder with a body mass index ≥27 and non-high-density lipoprotein (non-HDL) cholesterol ≥130 mg/dl who were on a stable treatment dosage of olanzapine, quetiapine, or risperidone were randomly assigned to switch to aripiprazole (N=109) for 24 weeks or stay on their current medication (N=106). All participants were enrolled in a behaviorally oriented diet and exercise program. Clinical raters were blinded to treatment assignment. The primary and key secondary outcomes were change in non-HDL cholesterol and efficacy failure, respectively. Results : The prespecified primary analysis included 89 switchers and 98 stayers who had at least one postbaseline non-HDL cholesterol measurement. The least squares mean estimates of non-HDL cholesterol decreased more for the switch group than for the stay group (-20.2 mg/ dl and -10.8 mg/dl, respectively). Switching was associated with larger weight reductions (least squares mean=2.9 kg) and a net reduction of serum triglycerides of 32.7 mg/dl. Twenty-two switchers (20.6{\%}) and 18 stayers (17.0{\%}) experienced protocol- defined efficacy failure. Forty-seven switchers (43.9{\%}) and 26 stayers (24.5{\%}) discontinued the assigned antipsychotic medication before 24 weeks. Conclusion : Switching to aripiprazole led to improvement of non-HDL cholesterol levels and other metabolic parameters. Rates of efficacy failure were similar between groups, but switching to aripiprazole was associated with a higher rate of treatment discontinuation. In the context of close clinical monitoring, switching from an antipsychotic with high metabolic risk to one with lower risk to improve metabolic parameters is an effective strategy.",
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AU - Stroup, T. Scott

AU - McEvoy, Joseph Patrick

AU - Ring, Kimberly D.

AU - Hamer, Robert H.

AU - LaVange, Lisa M.

AU - Swartz, Marvin S.

AU - Rosenheck, Robert A.

AU - Perkins, Diana O.

AU - Nussbaum, Abraham M.

AU - Lieberman, Jeffrey A.

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