Olanzapine-induced weight gain in patients with bipolar I disorder: a meta-analysis

Autor: Mina G. Nashed, Maria R. Restivo, Valerie H. Taylor
Rok vydání: 2011
Předmět:
Zdroj: The primary care companion for CNS disorders. 13(6)
ISSN: 2155-7780
Popis: Bipolar disorder, a chronic mental illness that impacts 1% of the population, is defined clinically by a wide range of symptoms: a depressed or euphoric mood, lack of activity paralleled at times with energized behavior, and a decreased need for sleep and social interaction that can manifest as either the desire for complete isolation or extreme extroversion that can become problematic.1 To further complicate the picture, individuals in either the manic or depressed phases of bipolar disorder can experience psychotic symptoms as well.1 As a consequence, the pharmacologic management of bipolar disorder involves a myriad of options from a variety of drug categories; mood stabilizers, antidepressants, and atypical antipsychotics are all recommended as first-line agents, either as monotherapy or in combination.1 Of these options, the most recent class of medications to become first line for acute and maintenance treatment of bipolar disorder is the second-generation atypical antipsychotics (SGAs). While these agents are heterogeneous in their efficacy and tolerability, studies suggest that SGAs, either alone or in combination with mood stabilizers, are currently an efficacious treatment strategy in the management of both the depressive and manic stages of bipolar disorder.2 Added benefits in favor of the use of SGAs include reduced extrapyramidal side effects and the absence of depressive symptom exacerbation.3 There are concerns associated with the use of this medication class, however, and the adverse metabolic profile associated with SGAs needs to be considered when making treatment recommendations. In terms of market share, the most commonly prescribed atypical antipsychotic worldwide is olanzapine.4 In 2003, olanzapine was approved for the treatment of bipolar depressive episodes in combination with fluoxetine,5 and in 2004 it was approved for long-term maintenance treatment of bipolar disorder.6 Since then, olanzapine has become the best-studied SGA in this patient population, but while significant weight gain has been consistently reported with the use of olanzapine in the treatment of bipolar disorder, there has not been a meta-analysis to comprehensively investigate the problem in this population. The bulk of work examining the weight gain side effects associated with olanzapine has focused on schizophrenia, and a 2009 meta-analysis by Leucht et al7 concluded that olanzapine was associated with 3.3-kg more weight gain when compared with haloperidol monotherapy (95% CI, 2.2–4.4, P < .001) in 9 studies on patients with schizophrenia. In 2 other meta-analyses, olanzapine was shown to cause more weight gain than any other SGA, with the exception of clozapine, in patients in schizophrenia.8,9 Results from schizophrenia studies are not always generalizable to other patient populations; therefore, a meta-analysis on the weight gain effects of olanzapine on patients with bipolar disorder is warranted. The aim of this study was to compare weight gain outcomes of olanzapine monotherapy to placebo and other monotherapies in patients with bipolar disorder. Clinical Points ▪Olanzapine monotherapy is associated with significantly more weight gain than placebo and other bipolar disorder medications that are known to cause moderate weight gain. ▪Weight gain may exacerbate other health risks associated with bipolar disorder, such as compromised neurocognitive function. ▪Clinician awareness regarding the adverse metabolic side effects of antipsychotics, such as olanzapine, will ensure that patients are able to safely choose the best medication to manage their complicated illness and improve medication compliance.
Databáze: OpenAIRE
Externí odkaz: