Efficacy and safety of add-on topiramate vs. metformin on cardiometabolic profile in patients of schizophrenia on atypical antipsychotics with metabolic syndrome: an active-controlled, rater-blinded, parallel-design randomized controlled trial.
Eur Arch Psychiatry Clin NeurosciAug 4, 2026 (epub)
Radhika Chakraborty, Debadatta Mohapatra, Tathagata Biswas et al.
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In 30 seconds
This randomized controlled trial compared the efficacy and safety of topiramate versus metformin in 60 patients with schizophrenia and metabolic syndrome. Both treatments improved cardiovascular risk scores, but topiramate showed a significantly greater improvement after adjusting for baseline scores (β = -0.324, p = 0.043).
Key findings
- Topiramate improved QRISK3 scores with a mean difference of 0.61 (0.02 to 1.21), p = 0.04.
- Metformin showed significant improvements in LDL: HDL ratio and HOMA-IR, but no significant between-group differences.
- Both treatments significantly improved PANSS and CGI-SCH scores without notable differences between groups.
- A moderate correlation was found between changes in QRISK3 and PANSS scores in the topiramate group.
Why it matters
The study highlights the potential of topiramate as an effective alternative to metformin for managing metabolic syndrome in patients with schizophrenia, particularly when metformin is not suitable.