Does duration of antipsychotic use predict their weight gain potential?

 

This is second part of our post on this topic.

First part is available here: Antipsychotics Induced Weight Gain.

 


This post will focus on answering following questions:

Q.1: Which antipsychotics showed NO statistically significant weight change post baseline?

Q.2: Which time period (duration) have more significant increase in weight gain?

Q.3: How is weight gain in antipsychotic naive patient subgroup?

Q.4: Will switching antipsychotics to aripiprazole, ziprasidone or amisulpride result in weight loss?

Q.5: Which factors are important to consider with weight gain from antipsychotics?

 


Drukker M et al published this meta-analysis to answer these questions. This meta-analysis was conducted of clinical trials of antipsychotics that reported weight change.

 

Outcome measures included:

    • Body weight changes in Kg.

    • Change in BMI (Body Mass Index) and

    • Clinically relevant weight change (7% weight gain or loss).

 

They also stratified based on duration of antipsychotics use:

  • Short term: ≤6 weeks.

  • Medium short term: 6–16 weeks.

  • Medium term: 16–38 weeks

  • Long term: >38 weeks. 

 


IMPORTANT FINDINGS OF THIS META-ANALYSIS:



Q.1: Which antipsychotics showed NO statistically significant weight change post baseline?

  1. Amisulpride

  2. Aripiprazole

  3. Asenapine

  4. Sertindole

  5. Ziprasidone


Q.2: Which time period (duration) have more significant increase in weight gain?

 

FIRST GENERATION ANTIPSYCHOTICS & OLANZAPINE: Weight gain higher for >38 week duration compared to 0-6 weeks.

  • Olanzapine (effect size for <6 wk: 2.55; >38 wk: 4.63).

  • Haloperidol (effect size for <6 wk: 0.71; >38 wk: 2.93).

OTHER ANTIPSYCHOTICS: did not showed statistically significant changes in body weight over time period. These includes:

  • Aripiprazole (effect size for <6 wk: 0.47; >38 wk: 0.46).

  • Asenapine (effect size for <6 wk: 1.25; >38 wk: 2.09).

  • Chlorpromazine (effect size for <6 wk: 2.81; 16-38 wk: 4.90; >38 wk: 1.91).

  • Clozapine (effect size for <6 wk: 4.27; >38 wk: 7.34).

  • Quetiapine (effect size for <6 wk: 1.54; >38 wk: 1.55).

  • Risperidone (effect size for <6 wk: 1.84; >38 wk: 2.58).

  • Paliperidone (effect size for <6 wk: 0.96; >38 wk: 0.99).

  • Ziprasidone (effect size for <6 wk: 0.68; >38 wk: 0.25).


Q.3: How is weight gain in antipsychotic naive patient subgroup?

 

This subgroup had more increase in mean weight and BMI: clinical weight gain of at least 20% in all antipsychotics. 

 

Thus antipsychotic naive patients are more vulnerable to weight gain. 

 


Q.4: Will switching antipsychotics to aripiprazole, ziprasidone or amisulpride result in weight loss?

 

According to this meta-analysis, this may not result in weight loss.

Note that patient’s did lost weight after they were switched to these antipsychotics, but post baseline weight change was neutral.

 

This study does not suggest that this switch will result in weight loss in long term.

 


Q.5: Which factors are important to consider with weight gain from antipsychotics?

 

(a) DIAGNOSIS: weight gain for schizophrenia > bipolar disorder. 

 

(b) BASELINE BMI: weight gain more for lower BMI (< 27.5) versus higher BMI (> 27.5).

 

(c) ANTIPSYCHOTIC NAIVE POPULATION: see details above.

 


SOURCE:
  • Bak M, Fransen A, Janssen J, van Os J, Drukker M. Almost all antipsychotics result in weight gain: a meta-analysis. PLoS One. 2014 Apr 24;9(4):e94112. doi: 10.1371/journal.pone.0094112. eCollection 2014. PubMed PMID: 24763306; PubMed Central PMCID: PMC3998960.

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Dr. Harvinder Singh, M.D. (Admin)


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