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Weight and body mass index increase in children and adolescents exposed to antipsychotic drugs in non-interventional settings: a meta-analysis and meta-regression.
Eur Child Adolesc Psychiatry. 2020 Jul 02 [Online ahead of print]EC

Abstract

Antipsychotics increase weight, BMI and waist size, particularly in pediatric patients. Switching antipsychotics is common practice, thus defining the risk for each antipsychotic in real-life settings can be important for clinical guidance. We conducted a meta-analysis on antipsychotic-related changes in body measures in pediatric observational studies. Of 934 publications found on PubMed, we analyzed 38, including nine treatment arms: no treatment, mixed antipsychotic treatment, first-generation antipsychotics, aripiprazole, clozapine, olanzapine, quetiapine, risperidone and ziprasidone. Changes in weight, BMI, BMI-Z and waist size were meta-analyzed according to the duration of clinical observations: 6, 12, > 12 months. Meta-regressions probed influencing factors. Weight in Kg was increased at 6, 12, > 12 months by olanzapine [+ 10.91, + 10.7, data not available (n/a)], mixed antipsychotic treatment (n/a, + 9.42, + 12.59), quetiapine (+ 5.84, n/a, n/a) and risperidone (+ 4.47, + 6.01, + 9.51) and without treatment (n/a, + 2.3, n/a). BMI was increased at 6, 12, > 12 months by olanzapine (+ 3.47, + 3.42, n/a), clozapine (n/a, + 3, n/a) mixed antipsychotic treatment (+ 3.37, + 2.95, + 3.32), risperidone (+ 2, + 2.13, + 2.16), quetiapine (+ 1.5, + 1.82, n/a), aripiprazole (n/a, + 1.7, + 2.1) and without treatment (n/a, + 0.75, n/a). BMI-Z was increased at 6, 12, > 12 months by olanzapine (+ 0.94, + 0.98, + 0.89), clozapine (n/a, + 0.8, n/a), risperidone (+ 0.62, + 0.61, + 0.48), quetiapine (+ 0.57, + 0.54, n/a), mixed antipsychotic treatment (+ 0.51, + 0.94, + 0.44), without treatment (n/a, + 0.37, n/a) and aripiprazole (no gain, + 0.31, n/a). Waist size in cm was increased at 6, 12 months by risperidone (+ 8.8, + 11.5), mixed antipsychotics treatment (+ 9.1, + 10.2) and quetiapine (+ 6.9, + 9.1). Overall, olanzapine and clozapine displayed maximum risk, followed by risperidone, quetiapine and aripiprazole (more risky at longer terms); ziprasidone was associated with no gains. No time-based trends emerged, suggesting a drug-specific risk magnitude. Meta-regressions evidenced variable roles for persistence in therapy and follow-up length, increased risk for drug-naïve patients, and a ceiling effect determined by higher baseline BMI/BMI-Z values.

Authors+Show Affiliations

Scientific Institute IRCCS E. Medea, 23892, Bosisio Parini, LC, Italy.Department of Translational Medical Sciences, Federico II University, Naples, Italy.Department of Child and Adolescent Psychiatry and Psychotherapy, Bolzano, Italy.Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania "Luigi Vanvitelli", Naples, Italy.Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania "Luigi Vanvitelli", Naples, Italy.Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, Fatebenefratelli-Sacco Hospital, "Luigi Sacco" University Hospital, Università Di Milano, Via GB Grassi 74, 20157, Milan, Italy.Scientific Institute IRCCS E. Medea, 23892, Bosisio Parini, LC, Italy.Department of Translational Medical Sciences, Federico II University, Naples, Italy.Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, Fatebenefratelli-Sacco Hospital, "Luigi Sacco" University Hospital, Università Di Milano, Via GB Grassi 74, 20157, Milan, Italy.Department of Translational Medical Sciences, Federico II University, Naples, Italy.Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, Fatebenefratelli-Sacco Hospital, "Luigi Sacco" University Hospital, Università Di Milano, Via GB Grassi 74, 20157, Milan, Italy. carla.carnovale@unimi.it.Department of Translational Medical Sciences, Federico II University, Naples, Italy. Department of Neuroscience, AORN Santobono-Pausilipon, Naples, Italy.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32617775

Citation

Pozzi, Marco, et al. "Weight and Body Mass Index Increase in Children and Adolescents Exposed to Antipsychotic Drugs in Non-interventional Settings: a Meta-analysis and Meta-regression." European Child & Adolescent Psychiatry, 2020.
Pozzi M, Ferrentino RI, Scrinzi G, et al. Weight and body mass index increase in children and adolescents exposed to antipsychotic drugs in non-interventional settings: a meta-analysis and meta-regression. Eur Child Adolesc Psychiatry. 2020.
Pozzi, M., Ferrentino, R. I., Scrinzi, G., Scavone, C., Capuano, A., Radice, S., Nobile, M., Formisano, P., Clementi, E., Bravaccio, C., Carnovale, C., & Pisano, S. (2020). Weight and body mass index increase in children and adolescents exposed to antipsychotic drugs in non-interventional settings: a meta-analysis and meta-regression. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-020-01582-9
Pozzi M, et al. Weight and Body Mass Index Increase in Children and Adolescents Exposed to Antipsychotic Drugs in Non-interventional Settings: a Meta-analysis and Meta-regression. Eur Child Adolesc Psychiatry. 2020 Jul 2; PubMed PMID: 32617775.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Weight and body mass index increase in children and adolescents exposed to antipsychotic drugs in non-interventional settings: a meta-analysis and meta-regression. AU - Pozzi,Marco, AU - Ferrentino,Roberta Ida, AU - Scrinzi,Giulia, AU - Scavone,Cristina, AU - Capuano,Annalisa, AU - Radice,Sonia, AU - Nobile,Maria, AU - Formisano,Pietro, AU - Clementi,Emilio, AU - Bravaccio,Carmela, AU - Carnovale,Carla, AU - Pisano,Simone, Y1 - 2020/07/02/ PY - 2020/03/27/received PY - 2020/06/22/accepted PY - 2020/7/4/entrez KW - Antipsychotic drugs KW - BMI KW - Observational KW - Pediatric KW - Weight JF - European child & adolescent psychiatry JO - Eur Child Adolesc Psychiatry N2 - Antipsychotics increase weight, BMI and waist size, particularly in pediatric patients. Switching antipsychotics is common practice, thus defining the risk for each antipsychotic in real-life settings can be important for clinical guidance. We conducted a meta-analysis on antipsychotic-related changes in body measures in pediatric observational studies. Of 934 publications found on PubMed, we analyzed 38, including nine treatment arms: no treatment, mixed antipsychotic treatment, first-generation antipsychotics, aripiprazole, clozapine, olanzapine, quetiapine, risperidone and ziprasidone. Changes in weight, BMI, BMI-Z and waist size were meta-analyzed according to the duration of clinical observations: 6, 12, > 12 months. Meta-regressions probed influencing factors. Weight in Kg was increased at 6, 12, > 12 months by olanzapine [+ 10.91, + 10.7, data not available (n/a)], mixed antipsychotic treatment (n/a, + 9.42, + 12.59), quetiapine (+ 5.84, n/a, n/a) and risperidone (+ 4.47, + 6.01, + 9.51) and without treatment (n/a, + 2.3, n/a). BMI was increased at 6, 12, > 12 months by olanzapine (+ 3.47, + 3.42, n/a), clozapine (n/a, + 3, n/a) mixed antipsychotic treatment (+ 3.37, + 2.95, + 3.32), risperidone (+ 2, + 2.13, + 2.16), quetiapine (+ 1.5, + 1.82, n/a), aripiprazole (n/a, + 1.7, + 2.1) and without treatment (n/a, + 0.75, n/a). BMI-Z was increased at 6, 12, > 12 months by olanzapine (+ 0.94, + 0.98, + 0.89), clozapine (n/a, + 0.8, n/a), risperidone (+ 0.62, + 0.61, + 0.48), quetiapine (+ 0.57, + 0.54, n/a), mixed antipsychotic treatment (+ 0.51, + 0.94, + 0.44), without treatment (n/a, + 0.37, n/a) and aripiprazole (no gain, + 0.31, n/a). Waist size in cm was increased at 6, 12 months by risperidone (+ 8.8, + 11.5), mixed antipsychotics treatment (+ 9.1, + 10.2) and quetiapine (+ 6.9, + 9.1). Overall, olanzapine and clozapine displayed maximum risk, followed by risperidone, quetiapine and aripiprazole (more risky at longer terms); ziprasidone was associated with no gains. No time-based trends emerged, suggesting a drug-specific risk magnitude. Meta-regressions evidenced variable roles for persistence in therapy and follow-up length, increased risk for drug-naïve patients, and a ceiling effect determined by higher baseline BMI/BMI-Z values. SN - 1435-165X UR - https://www.unboundmedicine.com/medline/citation/32617775/Weight_and_body_mass_index_increase_in_children_and_adolescents_exposed_to_antipsychotic_drugs_in_non-interventional_settings:_a_meta-analysis_and_meta-regression L2 - https://dx.doi.org/10.1007/s00787-020-01582-9 DB - PRIME DP - Unbound Medicine ER -
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