SGA treatment raises risk of metabolic disturbances

Second-generation antipsychotics (SGAs), used alone or with other psychotropic medications, are associated with metabolic disturbances, primarily weight gain and losses in triglyceride and high-density lipoprotein (HDL) values, a retrospective study in 128 youngsters showed. However, the changed values usually were within the normal reference values and often were not recognized.

The study, conducted in Finland, examined the records of patients (81% boys) aged younger than 13 years (median age, 9.4 years) who had SGA treatment during the 1-year study period. Most (94%) of the children were treated with risperidone at some point, 18% with aripiprazole, and 17% with quetiapine. Reported adverse reactions most often were increased appetite (in 36%), weight gain (33%), and fatigue (32%), along with neurologic reactions in 10%.

Body mass index z-score increased in three-quarters of patients for whom these figures were available, although this rise was within the normal weight category in more than half of patients. Weight gain was most apparent in patients treated only with an SGA or an SGA plus melatonin. Patients who received an SGA and medication for attention-deficit/hyperactivity disorder (ADHD) were less likely to gain weight.

High-density lipoprotein decreased in 54% of participants for whom information was available but still was within the normal range in 89%. Of the 61 patients for whom at least 3 blood pressure (BP) percentiles were available, 2 met the criteria for elevated BP and 1 had hypertension. Investigators noted at least 1 hypertensive systolic BP value in almost half (47%) of patients who had ADHD medication combined with an SGA and in 9 (27%) of those who received only SGAs.

During the study period, fewer than one-third (31%) of patients were referred to a pediatric consultation other than cardiology. The findings of this study led the authors to conclude that practitioners need to monitor SGA-induced metabolic disturbances more systematically than they do now (Kakko K, et al. Acta Paediatr. 2020;109[2]:342-348).

Thoughts from Dr Farber

The SGAs are valuable medicines but come with many adverse effects, the most concerning of which relate to weight gain and metabolic changes. Standard of care is to monitor for adverse effects including performing blood tests, but apparently this is not often done in Finland, which has a public-funded health care system. I suspect that in this country we may do even worse.