Effects of cariprazine on cholesterol, glucose, and weight in patients with schizophrenia: a systematic review and meta-analysis

Background: Cariprazine is a second-generation antipsychotic approved for treating schizophrenia, acute manic or mixed episodes associated with bipolar I disorder, and major depressive disorder. Antipsychotic treatment is often associated with metabolic alterations, including weight gain, dyslipidemia, and increased risk of type 2 diabetes and cardiovascular disease. Objectives: We performed a systematic review and meta-analysis with the overarching aim of synthesizing study results that describe the effect of cariprazine on glucose and lipid homeostasis, as well as weight, in persons living with schizophrenia. Design: A systematic literature review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data sources and methods: We systematically searched three major electronic databases of medical and social science research papers (PubMed/MEDLINE, PsycINFO, and Cochrane Central Register of Controlled Trials (CENTRAL) for relevant titles and abstracts published between January 2014 and March 2025. Results: Using the Covidence platform, we included 12 studies for the systematic review and four randomized controlled studies for the meta-analysis. Meta-analysis revealed a significant difference in weight change between cariprazine and placebo; however, no significant differences were observed for total cholesterol or fasting glucose. Conclusion: This meta-analysis suggests that cariprazine, although associated with modest weight gain, does not cause significant alterations in lipid and glycemic profiles, confirming its favorable metabolic profile compared to other atypical antipsychotics. Trial registration: This study is registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY), 2025100014.