S225. A SYSTEMATIC REVIEW AND META-ANALYSIS OF PHARMACOLOGICAL INTERVENTIONS FOR REDUCTION OR PREVENTION OF WEIGHT GAIN IN SCHIZOPHRENIA
Notice bibliographique
Résumé
Weight gain is an extremely common problem in schizophrenia patients and is associated with morbidity and mortality. We conducted a Cochrane meta-analysis to determine the effects of pharmacological interventions aimed at reduction or prevention of weight gain in schizophrenia. We searched the Cochrane Schizophrenia Group’s Trials Register that is based on regular searches of CINAHL, BIOSIS, AMED, EMBASE, PubMed, MEDLINE, PsycINFO, and registries of clinical trials. There is no language, date, document type, or publication status limitations for inclusion of records in the register. We also searched reference sections within relevant papers, hand searched key journals, and contacted the first author of each relevant study and other experts to collect further information. We included all double blind randomized controlled trials examining any adjunctive pharmacological intervention for weight loss (treatment) or weight maintenance (prevention) in patients with schizophrenia or schizophrenia-like illnesses. We reliably selected, quality assessed and extracted data from studies. As endpoint and change data were combined in the analysis, mean differences (MD) of the change from baseline were calculated. The primary outcome measure was weight loss. Forty-four randomized controlled trials met the inclusion criteria for this review. Ten studies examined prevention of weight gain while on antipsychotics. Reboxetine may be slightly effective in preventing weight gain (Weight: MD -2.09 kg, 95% CI -3.12 to -1.05; participants = 111; studies = 3; BMI: MD -0.70, 95% CI -1.03 to -0.36; participants = 111; studies = 3) and but the quality of evidence is low as the studies are small and have all been conducted by the same group. We are uncertain about the other agents used in a preventive role because the quality of evidence is very low. Thirty-four studies examined reduction of weight gain with pharmacological interventions. Metformin is effective in bringing about modest weight loss (MD -3.45 kg, 95% CI -4.92 to -1.98 kg; participants = 569; studies = 8; BMI: MD -1.32 kg/m2, 95% CI -1.84 to -0.81 kg/m2; participants = 606; studies = 9). This effect is probably stronger in first episode psychosis (FEP) patients (Weight: MD -5.18 kg, 95% CI -6.22 to -4.14 kg; participants = 214; studies = 3; BMI: MD -1.87 kg/m2, 95% CI -2.19 to -1.56 kg/m2; participants = 214; studies = 3) compared to chronic patients (Weight: MD -2.0 kg, 95% CI -3.0 to -1.0 kg; participants = 355; studies = 5; BMI: MD -0.73 kg/m2, 95% CI -1.04 to -0.42 kg/m2; participants = 392; studies = 6). Metformin probably decreases fasting insulin levels and insulin resistance as well. The frequency of adverse effects did not differ between metformin and placebo groups. Other agents that may reduce weight include aripiprazole, topiramate, H2 antagonists such as nizatidine, and sibutramine but the quality of the evidence is low or very low making the effects uncertain. Importantly, none of the adjunctive treatment strategies result in higher dropout rates. Other than higher reports of anxiety with aripiprazole, none of the adjunctive treatment strategies appear to result in worsening of mental status. Accumulating evidence supports the safe use of pharmacological interventions to achieve modest weight loss. Reboxetine may be slightly effective in preventing weight gain while metformin has the most evidence for use as treatment of weight gain in schizophrenia. The small number of studies, small sample size, and short study duration limits interpretation for other agents. Future studies that are adequately powered, with longer treatment duration, will be needed in evaluating the efficacy and safety of interventions for managing weight gain further.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,019 | 0,056 |
| Méta-épidémiologie (sens strict) | 0,004 | 0,002 |
| Méta-épidémiologie (sens large) | 0,024 | 0,039 |
| Bibliométrie | 0,014 | 0,013 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,004 | 0,003 |
| Science ouverte | 0,003 | 0,002 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,015 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».