Risk for Dyslipidemia Spikes Early in Youth on Antipsychotics

TOPLINE Children who started an antipsychotic had elevated rates of dyslipidemia, with rates peaking nearly 62 times baseline over the first week of use. Risks decreased but remained elevated three months later and beyond, and continued during future treatment episodes. METHODOLOGY Researchers analyzed public healthcare records from Hong Kong over an 18-year period starting in 2005 of 15,219 children aged 6 to 17 years (59.7% male) who started on an antipsychotic.

The mean age at first prescription was 12.9 years. The analysis focused on 497 patients who experienced metabolic abnormalities during follow-up, including about 23% who had hyperglycemia and about 90% who had dyslipidemia. Primary outcomes included the earliest occurrence of hyperglycemia or dyslipidemia, medication treatment, or abnormal laboratory tests.

Observation time was divided into mutually exclusive periods: baseline unexposed time, pre-exposure (90 days before first initiation), first-episode exposure (0-91 days or longer), subsequent exposure episodes, and postexposure (30 days after discontinuation). TAKEAWAY The incidence rate of metabolic abnormalities from days 8 to 30 after initiation was higher than baseline (incidence rate ratio [IRR], 5.60; 95% CI, 2.93 - 10.70), and continued to increase from days 31 to 90 (IRR, 7.71; 95% CI, 5.15 - 11.55); the rate dropped slightly after three months (IRR, 3.94; 95% CI, 2.91 - 5.33).

For hyperglycemia, the first seven days of medication showed an elevated risk (IRR, 12.55; 95% CI, 2.99 - 52.63; P <.001), with continued elevation from days 31 to 90 (IRR, 5.93; 95% CI, 2.44 - 14.44; P <.001) and after three months (IRR, 4.03; 95% CI, 2.13 - 7.62; P <.001).

The risk for dyslipidemia peaked during the first seven days and (IRR, 61.93; 95% CI, 42.01 - 91.27; P <.001) remained high during days one to three months out (IRR, 7.41; 95% CI, 4.77 - 11.49; P <.001), and continued after this time (IRR, 3.96; 95% CI, 2.87-5.46; P <.001).

Children had continued elevated risk for overall metabolic abnormalities during subsequent antipsychotic treatment episodes (IRR, 3.71; 95% CI, 2.51 - 5.49; P <.001), including hyperglycemia (IRR, 4.57; 95% CI, 2.30 - 9.08; P <.001), and dyslipidemia (IRR, 3.76; 95% CI, 2.47 - 5.73; P <.001).

IN PRACTICE "These findings provide additional evidence regarding the early timing of metabolic abnormalities after antipsychotic initiation and are consistent with existing recommendations for metabolic monitoring during the first 3 months of treatment and continued surveillance thereafter," the study authors wrote.

SOURCE The study was led by Francisco Tsz Tsun Lai, PhD, of the Department of Pharmacology and Pharmacy at the Li Ka Shing Faculty of Medicine at the University of Hong Kong in China. It was published online on October 28 in JAMA Network Open . LIMITATIONS Mild, untreated cases may not have been captured.

Testing was more frequent around the initiation of antipsychotics, so some early abnormalities may have reflected delayed recognition of preexisting metabolic conditions rather than treatment effects. Reliable specimen collection and test order dates were not consistently available.

DISCLOSURES Various study authors reported receiving research grants and speaker honoraria, consulting fees, and serving on boards from the European Commission, the Research Grants Council of Hong Kong, IQVIA, the Pharmacy and Poisons Board of Hong Kong, and Takeda, among others.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.