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Pharmacological Add-On Treatments for Short-Term Control of Antipsychotic-Induced Weight Gain: A Systematic Review and Network Meta-Analysis

39 Pages Posted: 24 Sep 2018

See all articles by Chuanjun Zhuo

Chuanjun Zhuo

Tianjin Medical University - Department of Psychiatry; Shandong Mental Health Center - Department of Psychiatry; Nankai University - Department of Psychiatry and Morbidity

Weihua Yue

Peking University - National Clinical Research Center for Mental Disorders

Qishi Zheng

Singapore Clinical Research Institute

Xiangyang Gao

Government of the People's Republic of China - Chinese PLA General Hospital

Shen Li

Tianjin Medical University - Department of Psychiatry

Jie Li

Tianjin Medical University; Nankai University - Department of Psychiatry and Morbidity

Rixing Jing

Chinese Academy of Medical Sciences

Xueqin Song

Zhengzhou University - First Affiliated Hospital

Chunhua Zhou

Hebei Medical University

Rachel Upthegrove

University of Birmingham

More...

Abstract

Background: Antipsychotic drugs may lead to side effects such as obesity, diabetes, dyslipidemia, and cardiovascular disease. The current systematic review and network meta-analysis analyzes and provides an update on the clinical performance of these add-ons in comparison to placebo on body weight and body mass index (BMI) reductions.

Methods: A comprehensive literature search was performed on electronic databases: PubMed (1946-), Embase (1974-), Cochrane library (1992-), and OpenGrey (2000-) until 31 July 2018. Network meta-analyses, comparing the body weight change, BMI change and withdrawn due to adverse events of different pharmacological add-ons, was performed using a multivariate meta-regression model with random-effects, adopting a frequentist approach. To rank the prognosis for all add-ons, we used surface under the cumulative ranking (SUCRA) values.

Outcomes: From 614 potential studies identified, 27 eligible studies (n = 1,349 subjects) were included. All the studies demonstrated low to moderate risk of bias. For the analysis of body weight change, all add-ons except Ranitidine showed significant weight reductions comparing to placebo. The effectiveness rank based on SUCRA results from highest to lowest was Sibutramine, Topiramate, Metformin, Reboxetine, Ranitidine, and placebo. A similar pattern was seen for BMI change. The analysis of safety outcome did not detect significantly increased withdrawn number from the add-ons. Current evidence showed relatively good tolerance and safety of using the pharmacological add-ons.

Interpretation: Topiramate and Metformin are effective add-on treatments in controlling antipsychotic-induced weight gain, comparing to placebo. They are well tolerated in short-term period. Although Sibutramine has the highest rank of the effectiveness, its licence has been withdrawn in many countries due to its adverse effects. Hence, Sibutramine should not be adopted to treat antipsychotic-induced weight gain.

Funding Statement: This work was supported by grants from the Tianjin Health Bureau Foundation (2014KR02 to C.Z.) , National Natural Science Foundation of China ( 81871052 to C.Z.) and the Key Projects of the Natural Science Foundation of Tianjin, China (17JCZDJC35700 to C.Z.).

Declaration of Interests: The authors declare that they have no conflict of interest.

Ethics Approval Statement: Missing

Keywords: antipsychotic-induced weight gain; network meta-analysis; pharmacological add-ons

Suggested Citation

Zhuo, Chuanjun and Yue, Weihua and Zheng, Qishi and Gao, Xiangyang and Li, Shen and Li, Jie and Jing, Rixing and Song, Xueqin and Zhou, Chunhua and Upthegrove, Rachel, Pharmacological Add-On Treatments for Short-Term Control of Antipsychotic-Induced Weight Gain: A Systematic Review and Network Meta-Analysis (August 29, 2018). Available at SSRN: https://ssrn.com/abstract=3244959 or http://dx.doi.org/10.2139/ssrn.3244959

Chuanjun Zhuo (Contact Author)

Tianjin Medical University - Department of Psychiatry ( email )

Tianjin, 300000
China

Shandong Mental Health Center - Department of Psychiatry ( email )

Jining, 272191
China

Nankai University - Department of Psychiatry and Morbidity ( email )

Tianjin, 300222
China

Weihua Yue

Peking University - National Clinical Research Center for Mental Disorders

No. 38 Xueyuan Road
Haidian District
Beijing, Beijing 100871
China

Qishi Zheng

Singapore Clinical Research Institute

31 Biopolis Way
Nanos, 138669
Singapore

Xiangyang Gao

Government of the People's Republic of China - Chinese PLA General Hospital

Beijing, 100853
China

Shen Li

Tianjin Medical University - Department of Psychiatry

Tianjin, 300000
China

Jie Li

Tianjin Medical University

Tianjin, 300060
China

Nankai University - Department of Psychiatry and Morbidity

Tianjin, 300222
China

Rixing Jing

Chinese Academy of Medical Sciences

NO. 9, Dongdan Santiao
Beijing, Dongcheng District
China

Xueqin Song

Zhengzhou University - First Affiliated Hospital

1 Eastern Jianshe Road
Henan, 450052
China

Chunhua Zhou

Hebei Medical University

361 East Zhongshan Road
Shijiazhuang 050017
China

Rachel Upthegrove

University of Birmingham

Edgbaston, Birmingham B15 2TT
United Kingdom