Abstract
BackgroundThis study focuses on exploring the relationship between changes in appetite or eating behaviors and subsequent weight change for adult patients with schizophrenia or bipolar disorder treated with olanzapine and adjunctive potential weight mitigating pharmacotherapy. The aim is not to compare different weight mitigating agents, but to evaluate patients' characteristics and changes in their eating behaviors during treatment. Identification of patient subgroups with different degrees of susceptibility to the effect of weight mitigating agents during olanzapine treatment may aid clinicians in treatment decisions.MethodsData were obtained from 3 randomized, double-blind, placebo-controlled, 16-week clinical trials. Included were 158 patients with schizophrenia or bipolar disorder and a body mass index (BMI) ≥ 25 kg/m2 who had received olanzapine treatment in combination with nizatidine (n = 68), sibutramine (n = 42), or amantadine (n = 48). Individual patients were analyzed for categorical weight loss ≥ 2 kg and weight gain ≥ 1 kg. Variables that were evaluated as potential predictors of weight outcomes included baseline patient characteristics, factors of the Eating Inventory, individual items of the Eating Behavior Assessment, and the Visual Analog Scale.ResultsPredictors/correlates of weight loss ≥ 2 kg included: high baseline BMI, low baseline interest in food, and a decrease from baseline to endpoint in appetite, hunger, or cravings for carbohydrates. Reduced cognitive restraint, increase in hunger, and increased overeating were associated with a higher probability of weight gain ≥ 1 kg.ConclusionThe association between weight gain and lack of cognitive restraint in the presence of increased appetite suggests potential benefit of psychoeducational counseling in conjunction with adjunctive pharmacotherapeutic agents in limiting weight gain during antipsychotic drug therapy.Trial RegistrationThis analysis was not a clinical trial and did not involve any medical intervention.
Highlights
This study focuses on exploring the relationship between changes in appetite or eating behaviors and subsequent weight change for adult patients with schizophrenia or bipolar disorder treated with olanzapine and adjunctive potential weight mitigating pharmacotherapy
We evaluated the association between appetite, eating behaviors, and weight change in patients with schizophrenia or bipolar disorder treated with olanzapine and an adjunctive pharmacotherapy for the purpose of identifying potential predictors and correlates for weight changes
The analyses presented here utilize data from 3 clinical trials sponsored by Eli Lilly and Company, in adult patients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition – Text Revision (DSM-IV-TR) diagnosis of schizophrenia, schizoaffective disorder, schizophreniform disorder, or bipolar disorder, that examined the effects of nizatidine, sibutramine, or amantadine compared to placebo on weight change
Summary
This study focuses on exploring the relationship between changes in appetite or eating behaviors and subsequent weight change for adult patients with schizophrenia or bipolar disorder treated with olanzapine and adjunctive potential weight mitigating pharmacotherapy. The aim is not to compare different weight mitigating agents, but to evaluate patients' characteristics and changes in their eating behaviors during treatment. [2] Since 1996, the United States (US) prescribing information for olanzapine has advised clinicians of the potential for significant weight gain in more than 1/ 4 of patients during short-term therapy and in more than 1/2 of patients who receive long-term olanzapine therapy. The current prescribing information for olanzapine warns clinicians of the potential for short- and long-term weight gain during treatment. Patients treated with olanzapine showed the greatest treatment effectiveness as determined by measuring the length of time patients remained on their prescribed medication. Patients treated with olanzapine remained on their medication statistically significantly longer compared to patients treated with quetiapine or risperidone, but not compared to patients treated with perphenazine or ziprasidone. [6] olanzapine-treated patients gained significantly more weight than patients in the other treatment groups (p < .001), and significantly more patients treated with olanzapine reported potentially clinically significant weight gain ≥ 7% increase from baseline weight (p < .001) and discontinued treatment due to weight gain or changes in metabolic parameters (p < .001). [6]
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