The potential role of appetite in predicting weight changes during treatment with olanzapine

Michael Case,Jamie Karagianis,Tamas Treuer,Vicki Poole Hoffmann

doi:10.1186/1471-244x-10-72

Michael Case, Jamie Karagianis + Show 2 more

Open Access

https://doi.org/10.1186/1471-244x-10-72

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Abstract

BackgroundClinically significant weight gain has been reported during treatment with atypical antipsychotics. It has been suggested that weight changes in patients treated with olanzapine may be associated with increased appetite.MethodsData were used from adult patients for whom both appetite and weight data were available from 4 prospective, 12- to 24-week clinical trials. Patients' appetites were assessed with Eating Behavior Assessment (EBA, Study 1), Platypus Appetite Rating Scale (PARS, Study 2), Eating Inventory (EI, Study 3), Food Craving Inventory (FCI, Study 3), and Eating Attitude Scale (EAS, Study 4).ResultsIn Studies 1 (EBA) and 4 (EAS), patients who reported overall score increases on appetite scales, indicating an increase in appetite, experienced the greatest overall weight gains. However, in Studies 2 (PARS) and 3 (EI, FCI), patients who reported overall score increases on appetite scales did not experience greater weight changes than patients not reporting score increases. Early weight changes (2-4 weeks) were more positively correlated with overall weight changes than early or overall score changes on any utilized appetite assessment scale. No additional information was gained by adding early appetite change to early weight change in correlation to overall weight change.ConclusionsEarly weight changes may be a more useful predictor for long-term weight changes than early score changes on appetite assessment scales.Clinical Trials RegistrationThis report represents secondary analyses of 4 clinical studies. Studies 1, 2, and 3 were registered at http://clinicaltrials.gov/ct2/home, under NCT00190749, NCT00303602, and NCT00401973, respectively. Study 4 predates the registration requirements for observational studies that are not classified as category 1 observational studies.

Highlights

Significant weight gain has been reported during treatment with atypical antipsychotics
Kroeze et al demonstrated that affinity to the histamine H1 receptor predicts weight gain associated with typical and atypical antipsychotics [9]
It is well known that executive functions are necessary to successfully manage eating behavior, and their impairment and disturbed weight regulation are often observed in patients with schizophrenia treated with antipsychotics

Summary

Introduction

Significant weight gain has been reported during treatment with atypical antipsychotics. It has been suggested that weight changes in patients treated with olanzapine may be associated with increased appetite. Kroeze et al demonstrated that affinity to the histamine H1 receptor predicts weight gain associated with typical and atypical antipsychotics [9]. Olanzapine and clozapine both have high affinities for the 5-HT2C and the histamine H1 receptors, while antagonism of peripheral M3 muscarinic receptor and effects on central 5-HT2C may potentially be related to treatmentemergent diabetes observed independent of obesity. Altered cognitive functions can independently affect the control of appetite [11] Treatment with both clozapine and olanzapine have been temporally associated with food craving and binge eating [12,13]

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