Abstract
Weight gain and metabolic disturbances, potentially influenced by increased appetite, are common effects of olanzapine treatment in patients with schizophrenia. In this study, we explored the association between olanzapine-induced weight gain and metabolic effects with increased appetite. Drug-naïve, first-episode schizophrenia patients were treated with olanzapine for 12 weeks. Assessments included time to increased appetite, body weight, body mass index, biochemical indicators of blood glucose and lipids, proportion of patients who gained more than 7% or 10% of their baseline weight upon treatment conclusion, patients who developed dyslipidemia, and Positive and Negative Syndrome Scale scores. In total, 33 patients with schizophrenia receiving olanzapine were enrolled and 31 completed the study. During the 12-week olanzapine treatment, 77.4% (24/31) patients had increased appetite with 58.1% (18/31) patients having increased appetite within the first 4 weeks. The mean time for increased appetite was 20.3 days. More patients in the increased appetite group increased their initial body weight by more than 7% after 12 weeks when compared to patients with unchanged appetite (22/24 [91.7%] vs. 3/7 [42.9%], p = 0.004). Earlier increased appetite led to more weight gain during the following month. Overall, 50% of patients in the increased appetite group had dyslipidemia after 12 weeks. Our results demonstrated that olanzapine induced significantly appetite increase in first-episode patients with schizophrenia and appetite increase played a key role in olanzapine-induced weight gain and dyslipidemia.Clinical Trial RegistrationNCT03451734. Registered March 2, 2018 (retrospectively registered).
Highlights
Olanzapine is one of the most widely used second-generation antipsychotics (SGAs) for schizophrenia, bipolar disorder, and psychotic symptoms
Participants were assessed for schizophrenia in accordance with criteria defined by the Diagnostic and Statistical Manual of Mental DisordersFifth Edition (DSM-5)
We investigated the association between weight, body mass index (BMI), insulin resistance index, LDLC, and appetite using linear regression analysis
Summary
Olanzapine is one of the most widely used second-generation antipsychotics (SGAs) for schizophrenia, bipolar disorder, and psychotic symptoms. Many randomized clinical trials (RCTs) and meta analyses have suggested that olanzapine is one of the most efficacious antipsychotic drugs in patients with schizophrenia (Leucht et al, 2013; Huhn et al, 2019). Considering the high obesity rate in patients with schizophrenia (42%), the potential risk of olanzapine-induced weight gain should be evaluated carefully (Newcomer, 2006). Some randomized controlled trial (RCT) studies have found that patients with mental diseases die up to 30 years earlier than the general population (Das-Munshi et al, 2017). A major risk factor for heart disease and premature death in these patients is weight gain (Fekadu et al, 2015)
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