The impact of weight gain on antipsychotic nonadherence or discontinuation: A systematic review and meta‐analysis

IF 5.3 2区 医学 Q1 PSYCHIATRY Acta Psychiatrica Scandinavica Pub Date : 2024-09-17 DOI:10.1111/acps.13758
Riddhita De, Emily C. C. Smith, Janani Navagnanavel, Emily Au, Kateryna Maksyutynska, Maria Papoulias, Raghunath Singh, Kristoffer J. Panganiban, Bailey Humber, Grimur Høgnason Mohr, Mette Ødegaard Nielsen, Bjørn H. Ebdrup, Gary Remington, Sri Mahavir Agarwal, Margaret K. Hahn
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Abstract

BackgroundNonadherence/discontinuation of antipsychotic (AP) medications represents an important clinical issue in patients across psychiatric disorders, including schizophrenia spectrum disorders (SSDs). While antipsychotic‐induced weight gain (AIWG) is a reported contributor to nonadherence, a systematic review of the association between AIWG and medication nonadherence/discontinuation has not been explored previously.MethodA systematic search was conducted in MEDLINE, EMBASE, PsychINFO, CINAHL, and CENTRAL databases, among others, to help identify all studies which explored adherence, study dropouts, AP switching and/or discontinuations attributable to AIWG among individuals with severe mental illness. A meta‐analysis was also completed where applicable.ResultsWe identified two categories of studies for the meta‐analysis. Category 1 included three studies, which compared measures of AP adherence or discontinuation across BMI classes/degrees of self‐reported weight gain. When compared to normal weight individuals receiving APs or those who did not report AIWG, individuals who were either overweight or obese or reported weight gain in relation to AP use had an increased odds of AP nonadherence (OR 2.37; 95% CI 1.51–3.73; p = 0.0002). Category 2 had 14 studies which compared measures of discontinuation related to weight gain reported as an adverse effect across different APs. Olanzapine was associated with a 3.32 times (95% CI 2.32–4.74; p < 0.00001) increased likelihood of nonadherence or discontinuation when compared to other APs with lower weight gain liabilities. Similarly, APs with moderate weight gain liability (paliperidone, risperidone, and quetiapine) increased the odds of nonadherence or discontinuation by 2.25 (95% CI 1.31–3.87; p = 0.003) when compared to APs considered to have lower weight gain liability (i.e. haloperidol and aripiprazole). The qualitative summary also confirmed these findings.ConclusionThis review and meta‐analysis suggests that AIWG influences medication nonadherence/discontinuation, whereby APs with higher weight gain liability are associated with nonadherence/discontinuation. Additional studies are needed to confirm these findings.
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体重增加对不服用或停用抗精神病药物的影响:系统回顾和荟萃分析
背景抗精神病药物(AP)的不依从/停药是包括精神分裂症谱系障碍(SSD)在内的各种精神疾病患者的一个重要临床问题。方法 在MEDLINE、EMBASE、PsychINFO、CINAHL和CENTRAL等数据库中进行了系统检索,以帮助确定所有探讨严重精神疾病患者因AIWG而导致的依从性、研究辍学、抗精神病药物转换和/或停药的研究。在适用的情况下,我们还完成了一项荟萃分析。结果我们为荟萃分析确定了两类研究。第一类包括三项研究,这些研究比较了不同 BMI 等级/自我报告体重增加程度的 AP 依从性或停药情况。与接受 AP 或未报告 AIWG 的正常体重者相比,超重或肥胖或报告体重增加与 AP 使用有关的人不坚持 AP 的几率更高(OR 2.37;95% CI 1.51-3.73;P = 0.0002)。第 2 类共有 14 项研究,这些研究比较了与不同 APs 的不良反应体重增加有关的停药措施。与体重增加责任较低的其他 APs 相比,奥氮平导致不依从或停药的可能性增加了 3.32 倍 (95% CI 2.32-4.74; p < 0.00001)。同样,与被认为具有较低体重增加责任的 APs(即氟哌啶醇和阿立哌唑)相比,具有中等体重增加责任的 APs(帕潘利酮、利培酮和喹硫平)使不依从或停药的几率增加了 2.25 (95% CI 1.31-3.87; p = 0.003)。结论本综述和荟萃分析表明,AIWG 会影响药物的不依从性/停药,其中体重增加责任较高的 APs 与不依从性/停药相关。还需要更多的研究来证实这些发现。
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来源期刊
Acta Psychiatrica Scandinavica
Acta Psychiatrica Scandinavica 医学-精神病学
CiteScore
11.20
自引率
3.00%
发文量
135
审稿时长
6-12 weeks
期刊介绍: Acta Psychiatrica Scandinavica acts as an international forum for the dissemination of information advancing the science and practice of psychiatry. In particular we focus on communicating frontline research to clinical psychiatrists and psychiatric researchers. Acta Psychiatrica Scandinavica has traditionally been and remains a journal focusing predominantly on clinical psychiatry, but translational psychiatry is a topic of growing importance to our readers. Therefore, the journal welcomes submission of manuscripts based on both clinical- and more translational (e.g. preclinical and epidemiological) research. When preparing manuscripts based on translational studies for submission to Acta Psychiatrica Scandinavica, the authors should place emphasis on the clinical significance of the research question and the findings. Manuscripts based solely on preclinical research (e.g. animal models) are normally not considered for publication in the Journal.
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