Weight Gain and Metabolic Risks Associated with Antipsychotic Medications in Children and Adolescents
Weight Gain and Metabolic Risks Associated with Antipsychotic Medications in Children and Adolescents
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DOI：
10.1089/cap.2011.0015
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发表时间：
2011-12-01
影响因子：
1.9
通讯作者：
Correll, Christoph U.
中科院分区：
文献类型：
--
作者：
Maayan, Lawrence;Correll, Christoph U.
背景：抗精神病药物相关的体重增加和代谢不良反应已成为主要关注点，尤其是在青少年中。方法：回顾抗精神病药物相关体重增加和代谢不良反应的随机、队列和药物流行病学研究，以及减少青少年体重增加的干预措施。结果：在 34 项已发表的针对精神病性和双相情感障碍青少年的头对头和安慰剂对照研究中，奥氮平的体重增加范围为 3.8 至 16.2 公斤（n = 353），氯氮平 0.9-9.5 千克（n = 97），利培酮 1.9-7.2 千克（n = 571），喹硫平 2.3-6.1 千克（n = 133），阿立哌唑 0-4.4 千克（n = 451）。在 24 项安慰剂对照试验中，患有双相情感障碍和精神分裂症的青少年中，体重增加≥7%所需的危害数字为，阿立哌唑为 39（置信区间 [CI]：-1 至 +6，不显着），齐拉西酮为 36（CI：-1 至 +7，不显着），喹硫平为 9（CI：7-14），喹硫平为 6（CI： 5-8) 为利培酮，3 (CI: 3-4) 为奥氮平。患有自闭症和破坏性行为障碍的青少年的数据（仅适用于某些抗精神病药物）表明体重增加较多，可能是由于先前接触抗精神病药物较少。一项针对未接受过抗精神病药物的青少年的大型队列研究的三个月结果表明，尽管所有研究的药物均显着增加了体重，但第二代抗精神病药物的代谢作用有所不同，这表明有额外的、与体重无关的作用。此外，药物流行病学研究表明，抗精神病药物联合用药会增加肥胖风险（比值比 [OR]：2.28 [CI：1.49-3.65]）或任何心血管、脑血管或高血压不良事件（OR：1.72 [CI：1.10-2.69]）的风险。然而，尽管体重明显增加且对青少年影响更大，但监测率较低，药理学和行为干预研究也极其有限。 结论：需要开展更多研究来制定策略，以尽量减少青少年中与抗精神病药物相关的体重增加和代谢影响，并发现潜在风险较低的治疗方法。
Background: Antipsychotic-related weight gain and metabolic adverse effects have become a major focus, especially in youth.Methods: Review of randomized, cohort, and pharmacoepidemiologic studies of antipsychotic-related weight gain and metabolic adverse effects and of interventions for their reduction in youth.Results: Across 34 published head-to-head and placebo-controlled studies in youth with psychotic and bipolar disorders, weight gain ranged from 3.8 to 16.2 kg with olanzapine (n = 353), 0.9-9.5 kg with clozapine (n = 97), 1.9-7.2 kg with risperidone (n = 571), 2.3-6.1 kg with quetiapine (n = 133), and 0-4.4 kg with aripiprazole (n = 451). In 24 placebo-controlled trials, the numbers-needed-to-harm for weight gain >= 7% in youth with bipolar disorder and schizophrenia were 39 (confidence interval [CI]: -1 to +6, not significant) for aripiprazole, 36 (CI: -1 to +7, not significant) for ziprasidone, 9 (CI: 7-14) for quetiapine, 6 (CI: 5-8) for risperidone, and 3 (CI: 3-4) for olanzapine. Data in youth with autism and disruptive behavior disorders, available only for some antipsychotics, suggest greater weight gain, possibly due to less prior antipsychotic exposure. Three-month results from a large cohort study in antipsychotic-naive youth indicated that metabolic effects differ among second-generation antipsychotics, despite significant weight gain with all studied agents, suggesting additional, weight-independent effects. Further, pharmacoepidemiologic work indicates that antipsychotic polypharmacy increases the risk for obesity (odds ratio [OR]: 2.28 [CI: 1.49-3.65]) or any cardiovascular, cerebrovascular, or hypertensive adverse event (OR: 1.72 [CI: 1.10-2.69]). However, despite marked weight gain and its greater impact on youth, monitoring rates are low and studies of pharmacologic and behavioral interventions are extremely limited.Conclusions: More research is needed to develop strategies to minimize antipsychotic-related weight gain and metabolic effects in youth and to discover treatments with lower risk potential.