Atypicals have different risk profiles for diabetes
Patients treated with atypical antipsychotic agents should be monitored carefully given the increased risk of weight gain and diabetes associated with this group of drugs, according to the American Diabetes Association and other US medical groups.
There has been some debate as to whether newer antipsychotic drugs increase
the risk of diabetes or whether higher background rates of diabetes are
prevalent among this patient population. To address this, the ADA held
a three-day meeting in November last year with the American Psychiatric
Association, the American Association of Clinical Endocrinologists and
the North American Association for the Study of Obesity.
As a result of the meeting a consensus statement was issued. It suggests
that there are different risks associated with different atypical antipsychotics
and that these risks should be considered when prescribing decisions
are made. In particular, it points to olanzapine (Zyprexa) and clozapine
(Clozaril) as the atypicals with the worst record for weight gain, increasing
diabetes risk and worsening lipid profile. It suggests that atypical
antipsychotics that have a lower propensity for weight gain and glucose
intolerance should be used to treat patients with, or at higher risk
for, diabetes and in those treated with other drugs that may increase
these risks.
Lilly, manufacturer of Zyprexa, rejects one of the conclusions of the
consensus statement that atypical antipsychotics differ in their diabetes
risk profiles. The company says that the finding is not supported by
the total evidence available, and that it is in direct conflict with
information issued by the FDA. The FDA has recently stated: “Precise
risk estimates for hyperglycaemia-related adverse events in patients
treated with atypical antipsychotics are not available.”
While Lilly concedes that most of the conclusions to come from the ADA
meeting are sensible, the company is concerned that inconsistency between
FDA information and the consensus statement will confuse patients and
prescribers. “This could potentially lead to inappropriate discontinuation
of certain medications and a lack of appropriate monitoring for all patients,
which could have life-threatening consequences,” Lilly warns.
Novartis, manufacturer of Clozaril, seems less concerned by the ADA’s
findings. A spokeswoman told The Journal that the increased risk of metabolic
side effects associated with Clozaril has been known about for several
years and that prescribing information for the drug was updated to include
this information in 2000. |
The
Pharmaceutical Journal