Efficacy of adjunctive treatments added to olanzapine or clozapine for weight control in patients with schizophrenia: a systematic review and meta-analysis.

Yun-Jung Choi

doi:10.1155/2015/970730

Abstract

Objectives. This study was conducted to review systematically adjunctive treatments for weight reduction in patients with schizophrenia and compare efficacies of clinical trials through meta-analysis, so as to provide effective clinical guideline regarding weight control for patients taking atypical antipsychotics. Methods. Candidate clinical trials were identified through searching the Cochrane Central Register of Controlled Trials, PubMed, and PsycINFO. Fourteen randomized clinical trials were included for systematic review and meta-analysis from 132 potential trials. The Comprehensive Meta-Analysis version 2 was used for meta-analysis. Results. Difference in means and significances from meta-analyses regarding weight control by adjunctive treatments showed that topiramate, aripiprazole, or sibutramine was more effective than metformin or reboxetine. Psychiatric evaluations did not show statistically significant changes between treatment groups and placebo groups except topiramate adjunctive treatments. Adverse effects regarding adjunctive therapies were tolerable and showed statistically no significances compared to control groups. Conclusion. Though having several reports related to exacerbation of psychiatric symptoms, topiramate and aripiprazole are more efficacious than other medications in regard to weight reduction and less burden of critical adverse effects as well as being beneficial for clinical improvement.

Highlights

Patients with schizophrenia are predisposed to becoming overweight through lifestyle factors, including sedentary lives, unhealthy diet, and socioeconomic status [1]
Inclusion criteria for this research were treatment effectiveness from clinical trials of adjunctive treatments added on atypical antipsychotics for adult schizophrenia population and containing outcome data regarding weight and clinical evaluation
Secondary outcomes included psychiatric symptom evaluations measured by the brief psychiatric rating scale (BPRS), the positive and negative syndrome scale (PANSS), or the scale for assessment of positive symptom (SAPS)

Summary

Introduction

Patients with schizophrenia are predisposed to becoming overweight through lifestyle factors, including sedentary lives, unhealthy diet, and socioeconomic status [1]. Though research into underlying mechanisms has identified some risk factors such as H1 receptor affinity [2] and 5HT2c polymorphisms [3], the pharmacology of antipsychotic-induced weight gain is largely not understood and is very likely multifactorial [4]. Prevention of weight gain and treatment of obesity among patients with schizophrenia taking atypical antipsychotics have become a priority in clinical practice and represent a major public health problem [1, 6]. While switching to a more weight-neutral atypical antipsychotic agent offers promise in halting or reversing weight gain associated with an antipsychotic agent, many patients and their clinicians are reluctant to risk worsening or return of psychotic symptoms [4]. Various agents have been proposed as adjunctive treatments to attenuate antipsychotic-induced weight gain [7]

Objectives

Methods

Results

Discussion

Conclusion