Metabolic syndrome and drug discontinuation in schizophrenia: a randomized trial comparing aripiprazole olanzapine and haloperidol

Objective To determine whether the prescription of aripiprazole, compared with olanzapine and haloperidol, was associated with a lower frequency of metabolic syndrome ( MS ) and treatment discontinuation at 1 year. Method Patients were randomly assigned to be treated open‐label and according to usual clinical practice with either aripiprazole, olanzapine, or haloperidol and followed up for 1 year. Results Three hundred out‐patients with persistent schizophrenia were recruited in 35 mental health services. The intention‐to‐treat (ITT) analysis found no significant differences in the rate of MS between aripiprazole (37%), olanzapine (47%), and haloperidol (42%). Treatment discontinuation for any cause was higher for aripiprazole (52%) than for olanzapine (33%; OR , 0.41; P = 0.004), or haloperidol (37%; OR , 0.51; P = 0.030). No significant difference was found between olanzapine and haloperidol. Time to discontinuation for any cause was longer for olanzapine than for aripiprazole ( HR , 0.55; P < 0.001). No significant differences were found between haloperidol and aripiprazole, or between olanzapine and haloperidol. Conclusion The prescription of aripiprazole did not significantly reduce the rates of MS , but its treatment retention was worse. Aripiprazole cannot be considered the safest and most effective drug for maintenance treatment of schizophrenia in routine care, although it may have a place in antipsychotic therapy.