Metformin for the prevention of clozapine-induced weight gain: A retrospective naturalistic cohort study.

Autor: Stogios N; Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.; Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada., Maksyutynska K; Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.; Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada., Navagnanavel J; Human Biology Department, University of Toronto, Toronto, Canada., Sanches M; Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health (CAMH), Toronto, Canada., Powell V; Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada., Gerretsen P; Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.; Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.; Department of Psychiatry, University of Toronto, Toronto, Canada., Graff-Guerrero A; Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.; Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.; Department of Psychiatry, University of Toronto, Toronto, Canada., Chintoh AF; Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.; Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.; Department of Psychiatry, University of Toronto, Toronto, Canada., Foussias G; Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.; Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.; Department of Psychiatry, University of Toronto, Toronto, Canada., Remington G; Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.; Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.; Department of Psychiatry, University of Toronto, Toronto, Canada., Hahn MK; Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.; Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.; Department of Psychiatry, University of Toronto, Toronto, Canada.; Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, Canada., Agarwal SM; Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.; Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.; Department of Psychiatry, University of Toronto, Toronto, Canada.; Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, Canada.
Jazyk: angličtina
Zdroj: Acta psychiatrica Scandinavica [Acta Psychiatr Scand] 2022 Sep; Vol. 146 (3), pp. 190-200. Date of Electronic Publication: 2022 Jun 25.
DOI: 10.1111/acps.13462
Abstrakt: Objective: Clozapine is presently the sole antipsychotic with an indication for treatment-resistant Schizophrenia, but is associated with significant weight gain and other metabolic aberrations. This retrospective chart review aimed to evaluate the effectiveness of adjunctive metformin in preventing clozapine-induced weight gain.
Methods: We conducted a retrospective chart review of patients newly initiated on clozapine at the Centre for Addiction and Mental Health in Canada, from November 2014 to April 2021. Our primary outcome was body weight at 6 and 12 months after clozapine initiation. Other metabolic parameters served as secondary outcomes.
Results: Among 396 patients (males: 71.5%, mean age: 42.8 years) initiated on clozapine, 69 were on metformin or prescribed it ≤3 months after clozapine initiation. The clozapine+metformin group demonstrated less weight gain compared with the clozapine-only group at 6 months (clozapine+metformin: -0.15 kg [SE = 1.08] vs. clozapine-only: 2.99 kg, SE = 0.54) and 12 months after clozapine initiation (clozapine+metformin: -0.67 kg, SE = 1.22 vs. clozapine-only: 4.72 kg, SE = 0.67). Adaptive changes were also observed for fasting glucose (F = 3.10, p = 0.046) and triglycerides (F = 8.56, p < 0.001) in the clozapine+metformin group compared with clozapine only.
Conclusion: In this large retrospective naturalistic cohort study, co-prescription of clozapine and metformin was associated with less weight gain and related metabolic dysfunction at 6 and 12 months after initiation versus clozapine alone. These findings provide evidence for the effectiveness of metformin in preventing clozapine-induced weight gain; larger randomized controlled trials are needed to confirm these results.
(© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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