Key result
Ziprasidone was associated with the highest risk of QTc prolongation (HR 1.72) among second-generation antipsychotics in patients with schizophrenia, followed by amisulpride and olanzapine.
Why the study?
Second-generation antipsychotics can cause QTc prolongation, posing safety concerns and limiting clinical use.
Does the use of specific second-generation antipsychotics increase the risk of QTc prolongation in psychiatric patients?
Cohort (n=5,130)
No
Does the use of specific second-generation antipsychotics increase the risk of QTc prolongation in psychiatric patients?
Hazard Ratio: 1.72 (95% CI 1.03–2.85)
p-value: p=0.03
Ziprasidone, amisulpride, and olanzapine are associated with a significantly increased risk of QTc prolongation compared to other second-generation antipsychotics, highlighting the need for regular ECG monitoring.
May warrant ECG monitoring with these agents; leaves open causal confirmation versus other antipsychotics.
Background Second-generation antipsychotics (SGAs) can cause corrected QT interval (QTc) prolongation as a side-effect. This may limit their clinical use and pose safety concerns for patients. Aims To analyse the risk of QTc prolongation associated with eight second-generation antipsychotics and observe the timing characteristics of QTc prolongation events and subsequent changes in medication strategies. Methods Using data from the hospital information system of a large mental health centre, this retrospective cohort study included 5130 patients (median follow-up: 141.2 days) treated between 2007 and 2019. A marginal structural Cox model was used to compare the hazard ratios for QTc prolongation associated with various SGAs. Results The mean age of the cohort was 35.54 years (s.d. = 14.22), and 47.8% (N = 2454) were male. Ziprasidone, amisulpride and olanzapine were the only SGAs associated with QTc prolongation. Ziprasidone presented the highest risk (hazard ratio 1.72, 95% CI: 1.03–2.85, adjusted P = 0.03), followed by amisulpride (hazard ratio 1.56, 95% CI: 1.04–2.34, adjusted P = 0.03) and olanzapine (hazard ratio 1.40, 95% CI: 1.02–1.94, adjusted P = 0.04). Conclusion Ziprasidone, amisulpride and olanzapine are associated with increased risk of QTc prolongation. Regular electrocardiogram monitoring is recommended when clinicians prescribe such drugs.
No takes yet. Share an insight, caveat, or question.
He et al. (2025) conducted a cohort in Schizophrenia (n=5,130). Ziprasidone vs. Non-exposed group was evaluated on QTc prolongation (QTc >450 ms in males, >470 ms in females, or increase >60 ms from baseline) (HR 1.72, 95% CI 1.03-2.85, p=0.03). Ziprasidone was associated with the highest risk of QTc prolongation (HR 1.72) among second-generation antipsychotics in patients with schizophrenia, followed by amisulpride and olanzapine.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: