Melatonin and melatonin-agonists for metabolic syndrome components in patients treated with antipsychotics: A systematic review and meta-analysis

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Human Psychopharmacology: Clinical and Experimental Pub Date : 2021-10-22 DOI:10.1002/hup.2821

Alessandro Miola, Michele Fornaro, Fabio Sambataro, Marco Solmi

{"title":"Melatonin and melatonin-agonists for metabolic syndrome components in patients treated with antipsychotics: A systematic review and meta-analysis","authors":"Alessandro Miola, Michele Fornaro, Fabio Sambataro, Marco Solmi","doi":"10.1002/hup.2821","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objective</h3>\n \n <p>Metabolic side effects are a limiting factor in the use of antipsychotics, which remain the cornerstone of long-term management of patients with severe mental illness. There is contrasting evidence on a possible role of melatonin and melatonin-agonists in attenuating antipsychotic-induced metabolic abnormalities.</p>\n </section>\n \n <section>\n \n <h3> Design</h3>\n \n <p>We conducted a systematic review (PubMed, PsycInfo, Cochrane databases, up to August 2020) and a random-effect meta-analysis of double-blind, randomized placebo-controlled trials (RCTs) involving melatonin and melatonin-agonists in the treatment of antipsychotic-induced metabolic changes. The primary outcome was the standardized mean difference (SMD) of composite metabolic outcomes built with metabolic syndrome components. Secondary outcomes were individual metabolic syndrome components, and other anthropometric, glucose metabolism, lipid profile, and psychopathology measures.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Out of the initial 41 studies, six documented five separate RCTs randomizing 248 patients (126 to melatonin/ramelteon, 122 to placebo) affected by schizophrenia-spectrum disorders and bipolar disorder. Melatonin/ramelteon outperformed placebo on the primary outcome (SMD −0.28, 95% CI = −0.39 ÷ −0.168), as well as on all individual components of metabolic syndrome (systolic blood pressure MD −3.266, 95% CI = −6.020 ÷ −0.511; fasting glucose MD −3.766, 95% CI = −5.938 ÷ −1.593; triglycerides MD −9.800, 95% CI = −19.431 ÷ −0.169; HDL MD 2.995, 95% CI = 0.567 ÷ 5.423), except waist circumference.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Melatonin/ramelteon augmentation may be beneficial for non-anthropometric metabolic syndrome components in patients treated with antipsychotics.</p>\n </section>\n </div>","PeriodicalId":13030,"journal":{"name":"Human Psychopharmacology: Clinical and Experimental","volume":"37 2","pages":""},"PeriodicalIF":1.8000,"publicationDate":"2021-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"6","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Human Psychopharmacology: Clinical and Experimental","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/hup.2821","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 6

Abstract

Objective

Metabolic side effects are a limiting factor in the use of antipsychotics, which remain the cornerstone of long-term management of patients with severe mental illness. There is contrasting evidence on a possible role of melatonin and melatonin-agonists in attenuating antipsychotic-induced metabolic abnormalities.

Design

We conducted a systematic review (PubMed, PsycInfo, Cochrane databases, up to August 2020) and a random-effect meta-analysis of double-blind, randomized placebo-controlled trials (RCTs) involving melatonin and melatonin-agonists in the treatment of antipsychotic-induced metabolic changes. The primary outcome was the standardized mean difference (SMD) of composite metabolic outcomes built with metabolic syndrome components. Secondary outcomes were individual metabolic syndrome components, and other anthropometric, glucose metabolism, lipid profile, and psychopathology measures.

Results

Out of the initial 41 studies, six documented five separate RCTs randomizing 248 patients (126 to melatonin/ramelteon, 122 to placebo) affected by schizophrenia-spectrum disorders and bipolar disorder. Melatonin/ramelteon outperformed placebo on the primary outcome (SMD −0.28, 95% CI = −0.39 ÷ −0.168), as well as on all individual components of metabolic syndrome (systolic blood pressure MD −3.266, 95% CI = −6.020 ÷ −0.511; fasting glucose MD −3.766, 95% CI = −5.938 ÷ −1.593; triglycerides MD −9.800, 95% CI = −19.431 ÷ −0.169; HDL MD 2.995, 95% CI = 0.567 ÷ 5.423), except waist circumference.

Conclusions

Melatonin/ramelteon augmentation may be beneficial for non-anthropometric metabolic syndrome components in patients treated with antipsychotics.

查看原文本刊更多论文

抗精神病药物治疗患者代谢综合征的褪黑激素和褪黑激素激动剂:系统回顾和荟萃分析

目的代谢副作用是限制抗精神病药物使用的一个因素，是严重精神疾病患者长期治疗的基石。关于褪黑激素和褪黑激素激动剂在减轻抗精神病药物引起的代谢异常中的可能作用，有不同的证据。我们进行了一项系统综述(PubMed、PsycInfo、Cochrane数据库，截至2020年8月)，并对涉及褪黑激素和褪黑激素激动剂治疗抗精神病药物引起的代谢变化的双盲、随机安慰剂对照试验(rct)进行了随机效应荟萃分析。主要结局是由代谢综合征组成的复合代谢结局的标准化平均差(SMD)。次要结果是个体代谢综合征成分，以及其他人体测量、葡萄糖代谢、脂质谱和精神病理学测量。在最初的41项研究中，6项记录了5项独立的随机对照试验，随机分配了248名患有精神分裂症谱系障碍和双相情感障碍的患者(126名服用褪黑素/拉美替恩，122名服用安慰剂)。褪黑素/拉梅尔替恩在主要结局上优于安慰剂(SMD = - 0.28, 95% CI = - 0.39 ÷ - 0.168)，以及代谢综合征的所有个体成分(收缩压MD = - 3.266, 95% CI = - 6.020 ÷ - 0.511;空腹血糖MD = - 3.766, 95% CI = - 5.938 ÷ - 1.593;甘油三酯MD = - 9.800, 95% CI = - 19.431 ÷ - 0.169;HDL - MD为2.995,95% CI = 0.567 ÷ 5.423)，腰围除外。结论抗精神病药物治疗后，褪黑素/拉美替龙增强治疗可能对非人体测量代谢综合征成分有益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Human Psychopharmacology: Clinical and Experimental 医学-精神病学

CiteScore

4.10

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Human Psychopharmacology: Clinical and Experimental provides a forum for the evaluation of clinical and experimental research on both new and established psychotropic medicines. Experimental studies of other centrally active drugs, including herbal products, in clinical, social and psychological contexts, as well as clinical/scientific papers on drugs of abuse and drug dependency will also be considered. While the primary purpose of the Journal is to publish the results of clinical research, the results of animal studies relevant to human psychopharmacology are welcome. The following topics are of special interest to the editors and readers of the Journal: -All aspects of clinical psychopharmacology- Efficacy and safety studies of novel and standard psychotropic drugs- Studies of the adverse effects of psychotropic drugs- Effects of psychotropic drugs on normal physiological processes- Geriatric and paediatric psychopharmacology- Ethical and psychosocial aspects of drug use and misuse- Psychopharmacological aspects of sleep and chronobiology- Neuroimaging and psychoactive drugs- Phytopharmacology and psychoactive substances- Drug treatment of neurological disorders- Mechanisms of action of psychotropic drugs- Ethnopsychopharmacology- Pharmacogenetic aspects of mental illness and drug response- Psychometrics: psychopharmacological methods and experimental design