Table 14Summary SOE for KQ 3: Interventions for lipid control

OutcomeNumber of Studies (Subjects)SOE Domains:
ROB
Consistency
SOE Domains:
Directness
Precision
SOE; Effect Estimate
Psychotropic Medications: Atomoxetine, Ramelteon, Adjunctive Aripiprazole
Total cholesterol2 (232)Moderate
NAa
Direct
Imprecise
Insufficient; 1 study showing no effect on LDL cholesterol for atomoxetine, 1 study showing benefit on total cholesterol for ramelteon, 1 study showing benefit for adjunctive aripiprazole on total and LDL cholesterol
LDL cholesterol3 (269)Moderate
NAa
Direct
Imprecise
Physical function/HRQOL1 (207)Low
NA
NAInsufficient; 1 study showing no benefit
Adverse effects2 (243)Moderate
NAa
Direct
Imprecise
Insufficient; 1 study showed better mental health but more serious adverse events with adjunctive aripiprazole
Anticonvulsant Medications: Topiramate, Zonisamide
Total cholesterol1 (42)Low
NA
Direct
Imprecise
Insufficient; 1 study showing moderate benefit (mean difference, 10.2 mg%) with topiramate on LDL; 1 study showing no effect with zonisamide
LDL cholesterol2 (114)Moderate
Inconsistent
Direct
Imprecise
Physical function/HRQOLNo studiesNANAInsufficient
Adverse effectsNo studiesNANAInsufficient
Other Medications: Amantadine, Nizatidine
Total cholesterol2 (75)Low to High
NAa
Direct
Imprecise
Insufficient; single studies for amantadine and nizatidine showing no effect
LDL cholesterol2 (75)
Physical function/HRQOLNo studiesNANAInsufficient
Adverse effects1 (54)Low
NA
Indirect
Imprecise
Insufficient
Antipsychotic Switching
Total cholesterol4 (1376)Moderate
Inconsistent
Direct
Imprecise
Low for aripiprazole, insufficient for other antipsychotics; results varied by switching strategy. Only a switch to aripiprazole improved lipid values; switching to injectable olanzapine increased lipid values.
LDL cholesterol4 (1376)
Physical function/HRQOL1 (149)Low
NA
Direct
Imprecise
Insufficient
Adverse effects3 (1243)Moderate
Consistent
Indirect
Imprecise
Low that moderate to large differences are not present for serious adverse events or discontinuations due to adverse events
Insufficient for risk of psychiatric worsening
Behavioral Interventions
Total cholesterol2 (99)Moderate
Consistent
Direct
Imprecise
Insufficient
LDL cholesterol3 (156)Moderate
Consistent
Indirect
Imprecise
Insufficient; mean difference, 1.9 mg/dl (−6.1 to 9.9)
Physical function/HRQOLNo studiesNANAInsufficient
Adverse effects1 (49)High
NA
Indirect
Imprecise
Insufficient
Peer or family support interventions
All outcomesNo studiesNANAInsufficient

CI = confidence interval; CVD = cardiovascular disease; HRQOL = health-related quality of life; LDL = low-density lipoprotein; NA = not applicable; OR = odds ratio; RCT = randomized controlled trial; ROB = risk of bias; SOE = strength of evidence

a

Consistency rating does not apply where different drugs in the same general drug class are being summarized.

Consistency rating does not apply where different drugs in the same general drug class are being summarized.

From: Discussion

Cover of Interventions To Improve Cardiovascular Risk Factors in People With Serious Mental Illness
Interventions To Improve Cardiovascular Risk Factors in People With Serious Mental Illness [Internet].
Comparative Effectiveness Reviews, No. 105.
Gierisch JM, Nieuwsma JA, Bradford DW, et al.

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