Summary: In a 7-week, double-blind randomized controlled trial of 60 adults with schizophrenia (57 completed), aripiprazole (5 to 30 mg/day) was associated with significantly less weight gain than risperidone (2 to 10 mg/day); the mean BMI change was +0.4 with aripiprazole versus +1.1 with risperidone (p < 0.001). Between-group lipid differences favored aripiprazole but were not statistically significant, and decreased appetite was more common with aripiprazole.
PICO Summary
| Element | Detail |
|---|---|
| Population | 60 adults with schizophrenia randomized (57 completed); antipsychotic-naive or after at least a 1-week washout; single-centre 7-week double-blind RCT (Iran) |
| Intervention | Aripiprazole 5 to 30 mg/day (n approximately 30) |
| Comparison | Risperidone 2 to 10 mg/day (n approximately 30) |
| Outcome | Primary: BMI change +0.4 ± 0.2 (aripiprazole) vs +1.1 ± 0.3 (risperidone), p < 0.001. Triglycerides +7.3 vs +28.1 mg/dL and total cholesterol +0.1 vs +5.1 mg/dL, both not statistically significant. Decreased appetite 60.7% vs 20.7%, p = 0.002; increased appetite 39.3% vs 55.2%. PANSS reductions comparable. No 95% CI or ARR/NNT reported. |
Aripiprazole vs Risperidone: Metabolic Effects
RCT · schizophrenia · 7 weeks
Over 7 weeks, aripiprazole caused significantly less weight gain than risperidone (BMI +0.4 vs +1.1, p<0.001). Lipid differences favoured aripiprazole but were not significant.
Expert Commentary
This small double-blind randomized trial offers a modest but useful short-term signal: over 7 weeks, aripiprazole was associated with significantly less weight gain than risperidone, and the divergence in appetite was striking, with decreased appetite reported almost three times as often on aripiprazole. The verdict is that the primary BMI finding is internally consistent and supports the established view that aripiprazole is the more weight-sparing of the two agents over the short term. Caution is warranted, however, because the lipid trends, although directionally favorable, did not reach statistical significance, so claims of a broadly superior metabolic profile are not yet supported by these data. The dominant limitation is the design itself: 57 completers across two arms over only 7 weeks is underpowered for secondary cardiometabolic endpoints, and antipsychotic-induced metabolic harm typically accrues over months to years, well beyond this window. Can I use this with my patients? Cautiously yes, for a metabolically vulnerable adult starting an antipsychotic, these data reinforce favoring aripiprazole and monitoring appetite early as a practical proxy for trajectory, while recognizing that efficacy and tolerability must still be individualized. Longer multi-centre trials with lipid and glycaemic endpoints as primary outcomes, ideally reporting effect sizes with confidence intervals, would strengthen the case.
References
Rahimi Darehbagh R, Ghanizadeh A, Seyedoshohadaei SA. Assessing the metabolic impact of aripiprazole versus risperidone in the treatment of schizophrenia: a randomized double-blind controlled clinical trial. BMC Psychiatry. 2025;25(1):1097. doi:10.1186/s12888-025-07496-7