Antipsychotic-Induced Weight Gain: Dose-Response Meta-Analysis of Randomized Controlled Trials

被引:78
作者
Wu, Hui [1 ,2 ]
Siafis, Spyridon [1 ]
Hamza, Tasnim [3 ]
Schneider-Thoma, Johannes [1 ]
Davis, John M. [4 ,5 ]
Salanti, Georgia [3 ]
Leucht, Stefan [1 ,6 ]
机构
[1] Tech Univ Munich, Sch Med, Dept Psychiat & Psychotherapy, Munich, Germany
[2] Shanghai Jiao Tong Univ, Shanghai Mental Hlth Ctr, Shanghai Key Lab Psychot Disorders, Sch Med, Shanghai, Peoples R China
[3] Univ Bern, Inst Social & Prevent Med, Bern, Switzerland
[4] Univ Illinois, Psychiat Inst, Chicago, IL USA
[5] Maryland Psychiat Res Ctr, POB 21247, Baltimore, MD 21228 USA
[6] Kings Coll London, Inst Psychiat Psychol & Neurosci, Dept Psychiat, Dept Psychosis Studies, London, England
关键词
dose-response relationship; metabolic side- effects; olanzapine; risperidone; paliperidone; quetiapine; PALIPERIDONE EXTENDED-RELEASE; ACTING INJECTABLE RISPERIDONE; ACUTELY PSYCHOTIC-PATIENTS; PLACEBO-CONTROLLED TRIAL; DOUBLE-BLIND; ACUTE EXACERBATION; ACUTE SCHIZOPHRENIA; NEGATIVE SYMPTOMS; SCHIZOAFFECTIVE DISORDER; QUETIAPINE FUMARATE;
D O I
10.1093/schbul/sbac001
中图分类号
R749 [精神病学];
学科分类号
100204 [神经病学];
摘要
Background Weight gain is among the most important side-effects of antipsychotics. It is, however, unclear whether it is associated with antipsychotic doses. We aimed to fill this gap with a dose-response meta-analysis. Methods We searched multiple electronic databases (last update search June 2021) for all fixed-dose studies that investigated 16 second-generation antipsychotics and haloperidol in adults with acute exacerbation of schizophrenia or with negative symptoms. We estimated the dose-response curves by conducting random-effects dose-response meta-analyses. We used the restricted cubic spline to model the dose-response relationship. The primary outcome was mean weight gain in kg from baseline to endpoint, the secondary outcome was the number of patients with clinically important weight gain. Findings Ninety-seven studies with 333 dose arms (36 326 participants) provided data for meta-analyses. Most studies were short-term with median duration of 6 weeks (range 4 to 26 weeks). In patients with acute exacerbation, amisulpride, aripiprazole, brexpiprazole, cariprazine, haloperidol, lumateperone, and lurasidone produced mild weight gain in comparison to placebo (mean difference at any dose <= 1 kg), while more significant weight gain was observed by all other drugs. For most drugs, dose-response curves showed an initial dose-related increase in weight which plateaued at higher doses, while for others there was no plateau and some even had bell-shaped curves, meaning less weight gain to be associated with higher doses. Interpretation Second-generation antipsychotics do not only differ in their propensity to produce weight gain, but also in the shapes of their dose-response curves. This information is important for dosing decisions in clinical practice.
引用
收藏
页码:643 / 654
页数:12
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