SynthesisSchizophrenia bulletin2021
Does Switching Antipsychotics Ameliorate Weight Gain in Patients With Severe Mental Illness? A Systematic Review and Meta-analysis.
Synthesis in Schizophrenia bulletin, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
28 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Guideline
- Strategies for Switching between Oral Postsynaptic Antidopaminergic Antipsychotics in Patients with Schizophrenia: A Systematic Review.CNS drugs · 2025Pooled it
- Aripiprazole and Risperidone Present Comparable Long-Term Metabolic Profiles: Data From a Pragmatic Randomized Controlled Trial in Drug-Naïve First-Episode Psychosis.The international journal of neuropsychopharmacology · 2022Trial
- Population pharmacokinetic modeling of amisulpride drug interactions and a transporter binding analysis.European journal of clinical pharmacology · 2026Article
- Real-world comprehensive care of people living with schizophrenia: recommendations across different settings and clinical stages.World psychiatry : official journal of the World Psychiatric Association (WPA) · 2026Article
- The safety and efficacy of semaglutide in people with schizophrenia spectrum disorders: systematic review and meta-analysis of randomised controlled trials.BJPsych open · 2026Review
- Prevalence and risk profiles of metabolic abnormalities (PRIMA): a large-scale, multicenter cross-sectional study among inpatients with schizophrenia in China.BMC psychiatry · 2026Article
- Associations between second-generation antipsychotics and metabolic outcomes in patients with schizophrenia and metabolic abnormalities.Schizophrenia (Heidelberg, Germany) · 2026Article
- Delphi Consensus Among French Obesity Experts on Clinical Recommendations for Drug Prescription in Patients With Severe Obesity.Obesity reviews : an official journal of the International Association for the Study of Obesity · 2025Review
- Behind the Gaps: A Narrative Review of Healthcare Barriers for Individuals with Serious Mental Illness.Healthcare (Basel, Switzerland) · 2025Review
- Metformin for the Prevention of Antipsychotic-Induced Weight Gain: Guideline Development and Consensus Validation.Schizophrenia bulletin · 2025Article
- Do antipsychotics work in people with schizophrenia? A review of outcomes and effect sizes.CNS spectrums · 2025Review
- Latest findings challenge behavioural approaches to the management of antipsychotic-induced weight gain.BJPsych open · 2025Article
- Management of obesity with semaglutide or metformin in patients with antipsychotic-induced weight gain (MOSA): a non-randomised open-label pilot study.BMC psychiatry · 2024Article
- Trajectories of daily antipsychotic use and weight gain in people hospitalized for the first episode of psychosis.European psychiatry : the journal of the Association of European Psychiatrists · 2024Article
- Severe mental illness: cardiovascular risk assessment and management.European heart journal · 2024Article
- Human Hemoglobin and Antipsychotics Clozapine, Ziprasidone and Sertindole: Friends or Foes?International journal of molecular sciences · 2023Article
- Non-Classical Aspects of Obesity Pathogenesis and Their Relative Clinical Importance for Obesity Treatment.Healthcare (Basel, Switzerland) · 2023Review
- Review
- Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
Abstract
objectiveObesity and adverse metabolic outcomes in patients with severe mental illness are clinically significant but potentially preventable. Importantly, the evidence for switching to antipsychotics to reduce cardiometabolic burden is unclear.
methodPubMED, Embase, PsycINFO, and Cochrane were searched from inception to March 8, 2020. Articles reporting weight and metabolic changes after antipsychotic switching vs staying on the previous antipsychotic were meta-analyzed both across and within group.
resultsOf 61 identified studies, 59 were meta-analyzed (40% rated high quality). In the switch-vs-stay pairwise meta-analyses, only aripiprazole significantly reduced weight (-5.52 kg, 95% CI -10.63, -0.42, P = .03), while olanzapine significantly increased weight (2.46 kg, 95% CI 0.34, 4.57, P = .02). Switching to aripiprazole also significantly improved fasting glucose (-3.99 mg/dl, 95% CI -7.34, -0.64, P = .02) and triglycerides (-31.03 mg/dl, 95% CI -48.73, -13.34, P = .0001). Dropout and psychosis ratings did not differ between switch and stay groups for aripiprazole and olanzapine. In before-to-after switch meta-analyses, aripiprazole (-1.96 kg, 95% CI -3.07, -0.85, P < .001) and ziprasidone (-2.22 kg, 95% CI -3.84, -0.60, P = .007) were associated with weight loss, whereas olanzapine (2.71 kg, 95% CI 1.87, 3.55, P < .001), and clozapine (2.80 kg, 95% CI 0.26, 5.34, P = .03) were associated with weight gain. No significant weight or other cardiometabolic changes were observed when switching to amisulpride, paliperidone/risperidone, quetiapine, or lurasidone.
conclusionsSwitching antipsychotics to agents with lower weight gain potential, notably to aripiprazole and ziprasidone, can improve weight profile and other cardiometabolic outcomes. When choosing switch agents, both the weight gain potential of the pre- and post-switch antipsychotic must be considered. Antipsychotic switching in psychiatrically stable patients must be weighed against the risk of psychiatric worsening.
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What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.