Metformin in prevention and treatment of antipsychotic induced weight gain: a systematic review and meta-analysis.

Chathurie Suraweera,Madhubashinee Dayabandara,Nimali Wanniarachchi,Varuni Asanka De Silva,Suhashini S Ratnatunga,Raveen Hanwella

doi:10.1186/s12888-016-1049-5

Chathurie Suraweera, Madhubashinee Dayabandara + Show 4 more

Open Access

https://doi.org/10.1186/s12888-016-1049-5

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Abstract

BackgroundMost antipsychotics are associated with weight gain and other metabolic complications. Several randomized trials have shown metformin to be effective, but this still hasn’t been included in clinical guidelines on managing antipsychotic induced weight gain.MethodsAll double blind placebo controlled trials assessing the efficacy of metformin in the treatment of antipsychotic induced weight gain were included. Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE were searched for the period January 2000-December 2015. Meta-analysis was carried out using the random effects model.ResultsMeta analysis of 12 published studies with a total of 743 patients found that in patients treated with antipsychotics, metformin treatment resulted in significantly better anthropometric and metabolic parameters than placebo. The mean change in weight was −3.27 kg (95 % CI −4.66 to −1.89) (Z = 4.64, p < 0.001). Metformin compared to placebo resulted in significant reduction in BMI [−1.13 kg/m2 (95 % CI −1.61 to −0.66)] and insulin resistance index [−1.49 (95 % CI −2.40 to −0.59)] but not fasting blood sugar [−2.48 mg/dl (95 % CI −5.54 to 0.57].ConclusionThis meta-analysis confirms that metformin is effective in treating antipsychotic induced weight gain in patients with schizophrenia or schizoaffective disorder.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-1049-5) contains supplementary material, which is available to authorized users.

Highlights

IntroductionSeveral randomized trials have shown metformin to be effective, but this still hasn’t been included in clinical guidelines on managing antipsychotic induced weight gain
Most antipsychotics are associated with weight gain and other metabolic complications
Participant characteristics and diagnosis Participants of both sexes and all age groups with schizophrenia or schizoaffective disorder diagnosed according to DSM IV, DSM-5 or International Classification of Mental and Behavioural Disorders (ICD-10) criteria treated with antipsychotics were included [19,20,21]

Summary

Introduction

Several randomized trials have shown metformin to be effective, but this still hasn’t been included in clinical guidelines on managing antipsychotic induced weight gain. Most antipsychotics are associated with weight gain and other metabolic complications [1]. Prevalence of metabolic syndrome is higher in patients treated with antipsychotics than in drug naive patients with schizophrenia. Clozapine and olanzapine have the highest risk of weight gain while aripiprazole, lurasidone and ziprasidone have the lowest risk [4,5,6]. The standardized mortality ratio in schizophrenia is 1.5 times that of the general population [7].

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