Key result
Topiramate cuts body weight by ~5.4 kg vs placebo in AAP-induced metabolic disturbance, alongside other agents.
Why the study?
Existing systematic reviews and conventional meta-analyses provided few sufficient and comprehensive comparisons between pharmacological interventions for atypical antipsychotic-induced metabolic disturbance.
Do pharmacological interventions reduce body weight and BMI in adults with metabolic disturbance induced by atypical antipsychotics?
Meta-Analysis (n=3,467)
Do pharmacological interventions reduce body weight and BMI in adults with metabolic disturbance induced by atypical antipsychotics?
Mean Difference: -5.4 (95% CI -7.12–-3.68)
Zonisamide, metformin, GLP-1RAs, and nizatidine effectively alleviate atypical antipsychotic-induced weight gain and elevated BMI with acceptable tolerability.
Supports adjunctive pharmacotherapy for AAP-induced weight gain; extends Level 1 evidence for metabolic management in psychiatric populations.
BACKGROUND: There have been a few systematic reviews and conventional meta-analyses reporting effect of drugs on metabolic disturbance induced by atypical antipsychotics (AAPs). However, few of them provided sufficient and comprehensive comparisons between pharmacological interventions. AIMS: We aimed to qualitatively compare drugs' effect on AAPs-induced metabolic abnormalities by using network meta-analysis (NMA). METHODS: We searched PubMed, EMBASE, Web of Science, Cochrane Controlled Register of Trials (CENTRAL), and PsycINFO on March 26, 2019. Of 5889 records identified, 61 randomized clinical trials including 3467 participants were included. We estimated weighted mean difference (WMD) and odds ratio (OR) using NMA. We assessed the risk of bias of individual studies with the Review Manager 5.3. Primary outcomes included change of body weight and body mass index (BMI). Secondary outcomes included change of other cardiometabolic risk factors, acceptability, and tolerability. RESULTS: For body weight, topiramate (WMD -5.4, 95% CI -7.12 to -3.68), zonisamide (-3.44, 95% CI -6.57 to -0.36), metformin (-3.01, 95% CI -4.22 to -1.83), glucagon-like peptide-1 receptor agonists (GLP-1RAs) (-3.23, 95% CI -5.47 to -0.96), and nizatidine (-2.14, 95% CI -4.01 to -0.27) were significantly superior to placebo. Results regarding to BMI were similar to that of body weight. With respect to tolerability, only topiramate (OR 24, 95% CI 3.15 to 648) was inferior to placebo. CONCLUSIONS: Considering both efficacy and tolerability, evidence from this NMA indicates zonisamide, metformin, GLP-1RAs, and nizatidine in adults should be the first-line treatment for alleviating AAPs-induced weight gain or elevated BMI.
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Wang et al. (2021) conducted a meta-analysis in Metabolic disturbance induced by atypical antipsychotics (n=3,467). Pharmacological interventions (topiramate, zonisamide, metformin, GLP-1RAs, nizatidine) vs. Placebo was evaluated on Change of body weight (WMD -5.4, 95% CI -7.12 to -3.68). Topiramate (WMD -5.4; 95% CI -7.12 to -3.68), zonisamide, metformin, GLP-1RAs, and nizatidine significantly reduced body weight compared to placebo in adults with AAP-induced metabolic disturbance.
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