Effect of cariprazine on metabolic parameters in patients with affective disorders: A systematic review and meta-analysis

BACKGROUND: Cariprazine is a second-generation antipsychotic approved for treating schizophrenia, acute manic/mixed, and depressive episodes associated with bipolar I disorder, and as adjunctive treatment in major depressive disorder (MDD). Antipsychotic treatment is often associated with metabolic alterations, including weight gain, dyslipidemia, and increased risk of type 2 diabetes and cardiovascular disease. AIMS: We conducted a systematic review and meta-analysis to synthesize study results on the effects of cariprazine on glucose and lipid homeostasis, as well as weight, in persons living with affective disorders. METHODS: Using the Covidence platform, we included 19 studies for the systematic review and 4 randomized controlled studies for the meta-analysis. This study is registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols under protocol number 2025100044. Six meta-analyses focused on patients with bipolar disorder (BD), and six meta-analyses focused on patients with MDD, evaluating changes in weight, cholesterol, and glucose for both cariprazine 1.5 and 3 mg. RESULTS: Cariprazine showed a minimal impact on the metabolic profile in both BD and MDD. Notably, weight gain was statistically significant in both doses (i.e. 1.5, 3 mg), but in most cases not clinically meaningful. Results indicate that there was no statistically significant shift relative to placebo in fasting glucose, triglycerides, or cholesterol. CONCLUSIONS: Results from this meta-analysis suggest that cariprazine presents a favourable metabolic profile compared to other atypical antipsychotics.