Therapeutic drug monitoring in adolescents with anorexia nervosa for safe treatment with adjunct olanzapine.

Autor: Karwautz A; Eating Disorders Care and Research Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Wien, Austria., Zeiler M; Eating Disorders Care and Research Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Wien, Austria., Schwarzenberg J; Eating Disorders Care and Research Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Wien, Austria., Mairhofer D; Eating Disorders Care and Research Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Wien, Austria., Mitterer M; Eating Disorders Care and Research Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Wien, Austria., Truttmann S; Eating Disorders Care and Research Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Wien, Austria., Philipp J; Eating Disorders Care and Research Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Wien, Austria., Koubek D; Eating Disorders Care and Research Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Wien, Austria., Glüder M; Eating Disorders Care and Research Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Wien, Austria., Wagner G; Eating Disorders Care and Research Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Wien, Austria., Malcher A; Eating Disorders Care and Research Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Wien, Austria., Schöfbeck G; Eating Disorders Care and Research Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Wien, Austria., Laczkovics C; Eating Disorders Care and Research Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Wien, Austria., Rock HW; CIO Marburg GmbH, Fronhausen, Germany., Zanko A; Parklandklinik, Bad Wildungen, Germany., Imgart H; Parklandklinik, Bad Wildungen, Germany., Banaschewski T; Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Mannheim, Germany., Fleischhaker C; Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany., Correll CU; Berlin Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité University Medical Center, Berlin, Germany., Wewetzer C; Kliniken der Stadt Köln GmbH, Clinic for Child and Adolescent Psychiatry Holweide, Children's Hospital Amsterdamer Straße, Cologne, Germany., Walitza S; Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, Zürich, Switzerland., Taurines R; Department of Child and Adolescent Psychiatry, University of Würzburg, Würzburg, Germany., Fekete S; Department of Child and Adolescent Psychiatry, University of Würzburg, Würzburg, Germany., Romanos M; Department of Child and Adolescent Psychiatry, University of Würzburg, Würzburg, Germany., Egberts K; Department of Child and Adolescent Psychiatry, University of Würzburg, Würzburg, Germany., Gerlach M; Department of Child and Adolescent Psychiatry, University of Würzburg, Würzburg, Germany.
Jazyk: angličtina
Zdroj: European eating disorders review : the journal of the Eating Disorders Association [Eur Eat Disord Rev] 2024 Nov; Vol. 32 (6), pp. 1055-1068. Date of Electronic Publication: 2023 Aug 17.
DOI: 10.1002/erv.3022
Abstrakt: Objective: Medication is commonly used in anorexia nervosa (AN) despite largely missing high grade evidence. Olanzapine (OLZ) is the best-evidenced substance used off-label in this group, with conflicting outcome regarding BMI, clinical and safety parameters. Therefore, it is important to strictly assure quality of treatment with OLZ in AN by using 'Therapeutic Drug Monitoring' according to AGNP-guidelines, including serum levels and adverse drug reactions (ADRs) to support safety for adolescents with AN and attempt to generate an initial age- and disorder-specific therapeutic reference range.
Method: Sixty-five adolescents with AN (aged 10-18) treated with OLZ (98% female; 97.5% AN-restricting-type) were prospectively observed, ADRs reported, and correlations between dosage and serum levels measured at trough level were calculated, a preliminary therapeutic range defined.
Results: Mean dosage of OLZ was 8.15 (SD: 2.91) mg and 0.19 (SD: 0.07) mg/kg respectively, average concentration was 26.57 (SD: 13.46) ng/mL. Correlation between daily dosage/dosage per kg and serum level was 0.72 (**p < 0.001)/0.65 (**p < 0.001), respectively. ADRs with impairment were rare (6.3%). 75% improved clinically (CGI). BMI increased significantly by 1.5 kg/m 2 (t = 10.6, p < 0.001). A preliminary therapeutic reference range is 11.9 and 39.9 ng/mL.
Conclusions: OLZ in the hands of specialists is a well-tolerated and safe treatment adjunct for adolescents with AN.
(© 2023 The Authors. European Eating Disorders Review published by Eating Disorders Association and John Wiley & Sons Ltd.)
Databáze: MEDLINE
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