Influence of different second generation antipsychotics on the QTc interval: A pragmatic study

Area of Science:

• Cardiology
• Psychiatry
• Pharmacology

Background:

• Second-generation antipsychotics (SGAs) are widely used for psychosis treatment.
• QTc interval prolongation is a potential cardiac risk associated with some antipsychotics.
• Understanding differential QTc effects among SGAs is crucial for patient safety.

Purpose of the Study:

• To compare the influence of four second-generation antipsychotics (SGAs) on the QTc interval in patients with psychosis.
• To determine if significant differences in QTc prolongation exist among risperidone, olanzapine, quetiapine, and ziprasidone.

Main Methods:

• A pragmatic, randomized head-to-head trial involving 173 acute psychosis patients.
• Patients were randomized to sequences of risperidone, olanzapine, quetiapine, or ziprasidone.
• Electrocardiograms (ECGs) were recorded throughout follow-up to assess QTc interval changes during actual medication use.

Main Results:

• No statistically significant differences in QTc interval change per day were observed among the four SGAs.
• Linear mixed effects analyses showed comparable QTc interval slopes across treatment groups.
• The maximum recorded QTc interval was 462 ms, with no group exhibiting significant prolongation.

Conclusions:

• None of the investigated second-generation antipsychotics (risperidone, olanzapine, quetiapine, ziprasidone) caused statistically significant QTc prolongation.
• The study found no significant differences in QTc interval effects among these SGAs.
• These findings suggest comparable cardiac safety profiles regarding QTc interval for these SGAs in psychosis patients.