Evidence map›Paper›PMID 39113461›Full record

ArticleBJPsych open2024

Revisiting diabetes risk of olanzapine versus aripiprazole in serious mental illness care.

Denis Agniel, Sharon-Lise T Normand, John W Newcomer, Katya Zelevinsky, Jason Poulos, Jeannette Tsuei, Marcela Horvitz-Lennon

Abstract read
In one paragraph

Article in BJPsych open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Denis AgnielRAND Corporation, Santa Monica, California, USA.
Sharon-Lise T NormandDepartment of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA; and Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.
John W NewcomerDepartment of Psychiatry, Washington University School of Medicine, St Louis, Missouri, USA; and Thriving Mind South Florida, Miami, Florida, USA.
Katya ZelevinskyDepartment of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.
Jason PoulosDepartment of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.
Jeannette TsueiRAND Corporation, Santa Monica, California, USA.
Marcela Horvitz-LennonRAND Corporation, Boston, Massachusetts, USA; and Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts, USA.ORCID https://orcid.org/0000-0001-8120-9313

Funding

Improving Value of Publicly Funded Mental Health CareR01MH106682 · NIMH · RAND CORPORATION · PI HORVITZ-LENNON, MARCELA V, NORMAND, SHARON-LISE TERESA · 2016 to 2019
$2.6M
NIMH NIH HHS R01 MH106682
6 · The paper itself

Abstract

backgroundExposure to second-generation antipsychotics (SGAs) carries a risk of type 2 diabetes, but questions remain about the diabetogenic effects of SGAs.

aimsTo assess the diabetes risk associated with two frequently used SGAs.

methodThis was a retrospective cohort study of adults with schizophrenia, bipolar I disorder or severe major depressive disorder (MDD) exposed during 2008-2013 to continuous monotherapy with aripiprazole or olanzapine for up to 24 months, with no pre-period exposure to other antipsychotics. Newly diagnosed type 2 diabetes was quantified with targeted minimum loss-based estimation; risk was summarised as the restricted mean survival time (RMST), the average number of diabetes-free months. Sensitivity analyses were used to evaluate potential confounding by indication.

resultsAripiprazole-treated patients had fewer diabetes-free months compared with olanzapine-treated patients. RMSTs were longer in olanzapine-treated patients, by 0.25 months [95% CI: 0.14, 0.36], 0.16 months [0.02, 0.31] and 0.22 months [0.01, 0.44] among patients with schizophrenia, bipolar I disorder and severe MDD, respectively. Although some sensitivity analyses suggest a risk of unobserved confounding, E-values indicate that this risk is not severe.

conclusionsUsing robust methods and accounting for exposure duration effects, we found a slightly higher risk of type 2 diabetes associated with aripiprazole compared with olanzapine monotherapy regardless of diagnosis. If this result was subject to unmeasured selection despite our methods, it would suggest clinician success in identifying olanzapine candidates with low diabetes risk. Confirmatory research is needed, but this insight suggests a potentially larger role for olanzapine in the treatment of well-selected patients, particularly for those with schizophrenia, given the drug's effectiveness advantage among them.

Indexed as

Antipsychoticscausal inferencemachine learning methods

Identifiers

PMID39113461
PMCPMC11698215

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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 OpenQuestion graph.