Comparative risk of QTc prolongation induced by second-generation antipsychotics in the real world: retrospective cohort study based on a hospital information system.
Level 3 - non-randomized controlled study
Retrospective cohort study using electronic hospital records
PubMed 40059385 · doi:10.1192/bjo.2024.871
What was done
A retrospective cohort study was conducted using electronic hospital information system data from a large mental health centre between 2007 and 2019. The study included 5,130 patients (median follow-up: 141.2 days) to assess the risk of corrected QT interval (QTc) prolongation across eight second-generation antipsychotics (SGAs) using a marginal structural Cox model.
What was found
The mean age was 35.54 years (SD = 14.22) and 47.8% (n = 2,454) were male. Ziprasidone, amisulpride, and olanzapine were the only SGAs associated with QTc prolongation: - Ziprasidone: hazard ratio 1.72 (95% CI: 1.03–2.85, adjusted P = 0.03) - Amisulpride: hazard ratio 1.56 (95% CI: 1.04–2.34, adjusted P = 0.03) - Olanzapine: hazard ratio 1.40 (95% CI: 1.02–1.94, adjusted P = 0.04) Data and risk estimates for the remaining five SGAs were not provided in the abstract.
Why it matters
These findings provide real-world comparative safety estimates for cardiac repolarization risk across SGAs, highlighting specific drugs where baseline and follow-up electrocardiogram monitoring is most warranted.
Limits
This was a retrospective study conducted at a single mental health centre. The abstract does not specify the other five SGAs evaluated, the diagnostic cutoff used for QTc prolongation, drug doses, or unmeasured confounders such as baseline electrolyte abnormalities.
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- supports Geodon (ziprasidone) causes a significant degree of QT interval prolongation.