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Insulin resistance induced by olanzapine and other second-generation antipsychotics in Chinese patients with schizophrenia: a comparative review and meta-analysis

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Abstract

Purpose

This systematic review aimed to determine whether olanzapine is more likely than other second-generation antipsychotics (SGAs) to induce insulin resistance in patients with schizophrenia in China.

Methods

We reviewed all randomized controlled trials on insulin resistance and metabolic abnormalities caused by SGAs in the PubMed, China National Knowledge Infrastructure (CNKI), VIP, and Wanfang databases. Retrieved articles were published on or before December 2018. Meta-analysis was performed to determine the effect size of the treatment on the insulin resistance index (IRI), fasting blood glucose (FBG), and fasting insulin (FINS).

Results

Forty studies (3725 participants in total) were included. All studies contained data suitable for comparing aripiprazole vs. olanzapine, ziprasidone vs. olanzapine, and risperidone vs. olanzapine. Patients treated with olanzapine had higher IRI, FBG, and FINS levels than did patients treated with aripiprazole, ziprasidone, or risperidone, with significant differences (aripiprazole vs. olanzapine: FBG: standardized mean difference [SMD] = 0.72, 95% confidence interval [95%CI] − 0.82, − 0.61; FINS: SMD = − 0.8, 95%CI − 1.00, − 0.61; IRI: SMD = − 0.80, 95%CI − 0.99, − 0.61; ziprasidone vs. olanzapine: FBG: SMD = − 1.19, 95%CI − 1.30, − 1.08; FINS: SMD = − 0.66, 95%CI − 0.85, − 0.47; IRI: SMD = − 0.71, 95%CI − 0.88, − 0.55; risperidone vs. olanzapine: FBG: SMD = − 0.17, 95%CI − 0.34, − 0.00).

Conclusions

Existing data suggest that olanzapine is associated with a significantly greater risk of IRI, FBG, and FINS, while other agents are associated with relatively lower risks. Thus, olanzapine is more likely to induce insulin resistance than are other SGAs in schizophrenic patients in China.

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Author’s contributors

LY. Yu and SL. Wu participated in the design of the study, collection and analysis of data, drawing conclusions, and writing of the manuscript. They are the first author, and they contributed equally to this work. YH. Deng and LX. Yu participated in drawing conclusions and reviewing the manuscript. They are the co-author. J. Lei managed the literature searches and extracted data. She is the co-author. WY. Li participated in the design of the study, participated in drawing conclusions, and reviewing the manuscript. He is the corresponding author. All authors contributed to and have approved the final manuscript.

Funding

The work was financially supported by the National Natural Science Foundation of China under Grant No. 81573509.

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Authors and Affiliations

  1. Department of Pharmacy, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China

    Liangyu Yu, Sanlan Wu, Yahui Deng, Lixiu Yu & Weiyong Li

  2. College of Pharmacy, Hubei University of Chinese Medicine, Wuhan, People’s Republic of China

    Juan Lei

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  1. Liangyu Yu
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Correspondence to Weiyong Li.

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Yu, L., Wu, S., Deng, Y. et al. Insulin resistance induced by olanzapine and other second-generation antipsychotics in Chinese patients with schizophrenia: a comparative review and meta-analysis. Eur J Clin Pharmacol 75, 1621–1629 (2019). https://doi.org/10.1007/s00228-019-02739-5

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