Glucagon-like peptide-1 receptor agonists for antipsychotic-associated cardio-metabolic risk factors: A systematic review and individual participant data meta-analysis.
Adolescent
Adult
Aged
Antipsychotic Agents
/ adverse effects
Body Weight
/ drug effects
Cardiovascular Diseases
/ chemically induced
Drug Administration Schedule
Exenatide
/ administration & dosage
Female
Glucagon-Like Peptide-1 Receptor
/ agonists
Humans
Hypoglycemic Agents
/ administration & dosage
Liraglutide
/ administration & dosage
Male
Metabolic Diseases
/ chemically induced
Middle Aged
Obesity
/ chemically induced
Risk Factors
Schizophrenia
/ drug therapy
Weight Gain
/ drug effects
Young Adult
GLP-1RAs
antipsychotics
body weight loss
cardiovascular risk
obesity
schizophrenia
Journal
Diabetes, obesity & metabolism
ISSN: 1463-1326
Titre abrégé: Diabetes Obes Metab
Pays: England
ID NLM: 100883645
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
received:
27
07
2018
revised:
28
08
2018
accepted:
01
09
2018
pubmed:
7
9
2018
medline:
10
9
2019
entrez:
7
9
2018
Statut:
ppublish
Résumé
To evaluate if glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce antipsychotic-associated body weight gain in patients with schizophrenia, when compared to controls. We systematically searched PubMed/EMBASE/PsycINFO/Cochrane using the search terms '(antipsychotic and GLP-1RA)'. Individual participant data from studies randomizing patients to GLP-1RA or control were meta-analysed. The primary outcome was difference in body weight between GLP-1RA and control; secondary outcomes included cardio-metabolic variables and adverse drug reactions (ADRs). Multiple linear regression was conducted including sex, age, psychosis severity, metabolic variable, ADRs, and GLP-1RA agent. Three studies (exenatide once-weekly = 2; liraglutide once-daily = 1) provided participant-level data (n = 164, age = 40.0 ± 11.1 years, body weight = 105.8 ± 20.8 kg). After 16.2 ± 4.0 weeks of treatment, body weight loss was 3.71 kg (95% CI = 2.44-4.99 kg) greater for GLP-1RA versus control (p < 0.001), number-needed-to-treat ≥5% body weight loss = 3.8 (95% CI = 2.6-7.2). Waist circumference, body mass index, HbA1c, fasting glucose and visceral adiposity were each significantly lower with GLP-1RA. Sex, age, psychosis severity, nausea, any ADR, and GLP-1RA agent did not significantly impact outcomes. Body weight loss with GLP-1RAs was greater for clozapine/olanzapine-treated patients (n = 141) than other antipsychotics (n = 27) (4.70 kg, 95% CI = 3.13-6.27 vs. 1.5 kg, 95% CI = -1.47-4.47) (p < 0.001). Nausea was more common with GLP-1RAs than control (53.6% vs. 27.5%, p = 0.002, number-needed-to-harm = 3.8). GLP-1RAs are effective and tolerable for antipsychotic-associated body weight gain, particularly clozapine/olanzapine-treated patients. With few included patients, further studies are required before making routine use recommendations for GLP-1RAs.
Substances chimiques
Antipsychotic Agents
0
Glucagon-Like Peptide-1 Receptor
0
Hypoglycemic Agents
0
Liraglutide
839I73S42A
Exenatide
9P1872D4OL
Types de publication
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
293-302Subventions
Organisme : CIHR
Pays : Canada
Informations de copyright
© 2018 John Wiley & Sons Ltd.