抗精神病药物治疗患者体重增加的药理治疗效果比较。系统回顾和网络荟萃分析

IF 4.2 2区医学 Q1 PSYCHIATRY

Comprehensive psychiatry Pub Date : 2025-09-01 DOI:10.1016/j.comppsych.2025.152632

Zuzanna Goetz-Kundera , Bogusława Przekopińska , Patryk Walichniewicz , Maciej Niewada , Michał Lew-Starowicz

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引用次数: 0

摘要

背景：抗精神病药物治疗引起的体重增加是与死亡率增加相关的重要心脏代谢危险因素。方法按照PRISMA标准系统检索Medline、Cochrane Central Register of Clinical Trials和Science Direct。仅纳入了评估药物干预以减少成人抗精神病药物引起的体重增加的随机安慰剂对照试验。从基线提取的平均体重变化数据，以及定义可变性或分散性的参数。采用固定效应模型和随机效应模型。采用SUCRA对治疗进行排序。结果纳入了27项研究，包括17种药物。这些研究分为两组，时间范围分别小于或大于12 周。短期干预的比较显示，与安慰剂相比，尼扎替丁（MD -6,82; CI -13,36至- 0,55）和二甲双胍（MD -4,17; CI -8,02至- 0,64）具有显著优势。对于长期干预，与安慰剂相比，利拉鲁肽（MD -5,3; Cl - 6,93至- 3,75）、艾塞那肽（MD -4,17; Cl - 7,4至- 1,14）、二甲双胍（MD -2,08; Cl - 2,86至- 1,35）和samidorphan （MD -1,91; Cl - 3,31至- 0,51）显示出显著的益处。根据SUCRA分析，利拉鲁肽优于其他药物。解释：我们的网络荟萃分析比较了药物干预与抗精神病药物治疗相关的体重增加。二甲双胍和利拉鲁肽在治疗目标人群体重增加方面似乎有最有力的证据。本研究未获得任何公共、商业或非营利部门的资助机构的特别资助。

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Comparative effects of pharmacological treatment for weight gain in patients treated with antipsychotics. A systematic review and network meta-analysis

Background

Weight gain induced by antipsychotic treatment is a significant cardiometabolic risk factor associated with increased mortality.

Methods

Following PRISMA criteria Medline, Cochrane Central Register of Clinical Trials and Science Direct were systematically searched. Only randomised placebo-controlled trials evaluating pharmacological interventions to reduce antipsychotic drug-induced weight gain in adults were included.

Data on mean change in weight from baseline were extracted, together with parameters defining variability or dispersion. A fixed effects model and random effects mode were used. Treatments were ranked using SUCRA.

Outcomes

27 studies including 17 medications were included. The studies were divided into two groups with a time horizon of less or more than 12 weeks. A comparison of the short-term interventions showed significant advantages of nizatidine (MD -6,82; CI -13,36 to −0,55) and metformin (MD -4,17; CI -8,02 to −0,64) over placebo. For longer-term interventions, significant benefits were shown for liraglutide (MD -5,3; Cl −6,93 to −3,75), exenatide (MD -4,17; Cl −7,4 to −1,14), metformin (MD -2,08; Cl −2,86 to −1,35) and samidorphan (MD -1,91; CL −3,31 to −0,51) as compared to placebo. Liraglutide was superior to other drugs according to the SUCRA analysis.

Interpretation

Our network meta-analysis presents a comparison of pharmacological interventions to address weight gain associated with antipsychotic treatment. Metformin and liraglutide appear to have the strongest evidence for treating weight gain in the target group.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sector.

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来源期刊

Comprehensive psychiatry 医学-精神病学

CiteScore

12.50

自引率

1.40%

发文量

审稿时长

29 days

期刊介绍： "Comprehensive Psychiatry" is an open access, peer-reviewed journal dedicated to the field of psychiatry and mental health. Its primary mission is to share the latest advancements in knowledge to enhance patient care and deepen the understanding of mental illnesses. The journal is supported by a diverse team of international editors and peer reviewers, ensuring the publication of high-quality research with a strong focus on clinical relevance and the implications for psychopathology. "Comprehensive Psychiatry" encourages authors to present their research in an accessible manner, facilitating engagement with clinicians, policymakers, and the broader public. By embracing an open access policy, the journal aims to maximize the global impact of its content, making it readily available to a wide audience and fostering scientific collaboration and public awareness beyond the traditional academic community. This approach is designed to promote a more inclusive and informed dialogue on mental health, contributing to the overall progress in the field.