Efficacy should drive atypical antipsychotic treatment

doi:10.1136/bmj.326.7383.283/a

BMJ 2003;326:283 ( 1 February )

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Efficacy should drive atypical antipsychotic treatment

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EDITOR $---$ Koro et al say that olanzapine is associated with a clinically important and significant increased risk of diabetes.¹To date five other pharmacoepidemiological papers have been publishedabout the possible increase in risk for diabetes in patients receivingatypical antipsychotics.^2-6

All use a variety of methods and have come up with a variety of conclusions: clozapine poses a higher risk for diabetes forpatients younger than 40,² clozapine, risperidone, olanzapine,and quetiapine are associated with higher rates of diabetes amongpatients aged 20-34,³ neither clozapine nor risperidone posea higher risk,⁴ atypical antipsychotics may pose a higher risk,⁵and risperidone poses no additional significant risk as opposedto clozapine and olanzapine.⁶

Of these six studies, two have been funded and coauthored by a pharmaceutical manufacturer. ¹ ⁶ Two have used the samedatabase. ¹ ⁵

Missing from these analyses are important risk factors such as ethnic group, ¹ ² ⁵ ⁶ body mass index, ^1-4 ⁶ familyhistory . . . [Full text of this article]

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Assessment of independent effect of olanzapine and risperidone on risk of diabetes among patients with schizophrenia: population based nested case-control study: Carol E Koro, Donald O Fedder, Gilbert J L'Italien, Sheila S Weiss, Laurence S Magder, Julie Kreyenbuhl, Dennis A Revicki, and Robert W Buchanan
BMJ 2002 325: 243. [Abstract] [Full Text] [PDF]

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