Almost all antipsychotics result in weight gain Metaanalysis
- Slides: 37
Almost all antipsychotics result in weight gain. Meta-analysis Maarten Bak
Department 2
Severe Mental Illness Health Department 3
People with SMI decease at a younger age Department Munk-Laursen 2014 Ann Rev Clin Psych 4
In SMI life expectancy is shortened Man Female Department Nordentoft 2013 Plos. One 5
Risks of severe physical problems in SMI GAP =General Australian population Department Gladigau 2014 IMJ 6
Physical problems & SMI: review Department De Hert 2011 World Psych 7
DM-II Met. S Department Heald 2010 Eur Psych 8
CVD risico Department Mc. Lean 2014 Schiz Res 9
People with Schizophrenia decease at a younger age Department Munk-Laursen 2014 Ann Rev Clin Psych 10
Treatment of physical problems & SMI OR Meta-analysis of treatment with: Antiviral compounds, ACE-blockers, β-blockers, anticoagulants and Cholesterol decreasing medication Department Mitchell 2012 BJP 11
Severe Mental Illness Health Department Medication 12
Mortality risk & AP Largely explained by reduced risk of suicide Department Tiihonen 2009 Lancet 13
Mortality and medication Department Tenback 2012 J Clin Psy. Pharm 14
Monitor side effects Metabolic Other Body weight changes Movement disorders BMI Cardiovascular disorders Waist circumference Sexual problems Glucose Lipids Department Antipsychotic monitor (APM) 15
Department 16
Department Monitor volksgezondheid 2015 + AP Monitor 2016 17
Department Monitor volksgezondheid 2015 + AP Monitor 2016 18
First review: AP associated with weight gain Department Allison et al, 1999 Am J Psych 19
Weight change: meta-analysis Study duration: 4 -12 wks Compared with haloperidol Department Leucht 2009 Lancet 20
BMI changes in first episode schizophrenia Department Tarricone 2010 Psychol Med 21
Are all AP associated with weight gain? Are AP-naive patients more at risk? Is duration of AP-use related with more weight gain? Department 22
Flow chart Department Bak 2014 Plos. One 23
Figure 2. Weight change (in kg) period per antipsychotic medication. Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost All Antipsychotics Result in Weight Gain: A Meta. Analysis. PLo. S ONE 9(4): e 94112. doi: 10. 1371/journal. pone. 0094112 http: //journals. plos. org/plosone/article? id=info: doi/10. 1371/journal. pone. 0094112 Department 24
Figure 3. Weight change (kg) period only including AP-naive samples. Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost All Antipsychotics Result in Weight Gain: A Meta. Analysis. PLo. S ONE 9(4): e 94112. doi: 10. 1371/journal. pone. 0094112 http: //journals. plos. org/plosone/article? id=info: doi/10. 1371/journal. pone. 0094112 Department 25
Figure 4. BMI change period. Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost All Antipsychotics Result in Weight Gain: A Meta. Analysis. PLo. S ONE 9(4): e 94112. doi: 10. 1371/journal. pone. 0094112 http: //journals. plos. org/plosone/article? id=info: doi/10. 1371/journal. pone. 0094112 Department 26
Figure 5. BMI change in AP naive patients per time period. Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost All Antipsychotics Result in Weight Gain: A Meta. Analysis. PLo. S ONE 9(4): e 94112. doi: 10. 1371/journal. pone. 0094112 http: //journals. plos. org/plosone/article? id=info: doi/10. 1371/journal. pone. 0094112 Department 27
Figure 6. Proportion of weight increase per antipsychotic per time period. Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost All Antipsychotics Result in Weight Gain: A Meta. Analysis. PLo. S ONE 9(4): e 94112. doi: 10. 1371/journal. pone. 0094112 http: //journals. plos. org/plosone/article? id=info: doi/10. 1371/journal. pone. 0094112 Department 28
Figure 7. Proportion of weight increase in AP naïve. Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost All Antipsychotics Result in Weight Gain: A Meta. Analysis. PLo. S ONE 9(4): e 94112. doi: 10. 1371/journal. pone. 0094112 http: //journals. plos. org/plosone/article? id=info: doi/10. 1371/journal. pone. 0094112 Department 29
Figure 8. Proportion of weight reduction. Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost All Antipsychotics Result in Weight Gain: A Meta. Analysis. PLo. S ONE 9(4): e 94112. doi: 10. 1371/journal. pone. 0094112 http: //journals. plos. org/plosone/article? id=info: doi/10. 1371/journal. pone. 0094112 Department 30
Table 1. Metaregression of weight changes period. Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost All Antipsychotics Result in Weight Gain: A Meta. Analysis. PLo. S ONE 9(4): e 94112. doi: 10. 1371/journal. pone. 0094112 http: //journals. plos. org/plosone/article? id=info: doi/10. 1371/journal. pone. 0094112 Department 31
Table 2. Metaregression of weight changes period in drug-naive patients. Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost All Antipsychotics Result in Weight Gain: A Meta. Analysis. PLo. S ONE 9(4): e 94112. doi: 10. 1371/journal. pone. 0094112 http: //journals. plos. org/plosone/article? id=info: doi/10. 1371/journal. pone. 0094112 Department 32
Is diagnosis a factor? Data period: 1960 – 2015 437 papers Department 33
No med Light med Moderate med Severe med <6 6 -16 1638 >38 1 1 1 1 Aff 0. 29 1. 64 0. 27 -0. 81 -1. 03 -0. 98 9. 54 -5. 13 -0. 23 -0. 1 -1. 09 -0. 53 -0. 17 -1. 77 1. 14 Cog 0. 37 -1. 92 -4. 75 Sz Psy NAO 0. 46 -0. 1 Add -1. 27 -2. 0 2. 97 No 0. 34 Rest -0. 98 Department -0. 8 0. 52 -0. 9 -1. 51 34
Remt “reward” systeem D 2 blokkade negatieve feedback Leptine stijgt Appetite stijgt Department Vergroot honger gevoel en eetlust Meer voedsel intake 35
Intake changes in rats after AP use Department Kaur & Kulkarni 2002 PNBP 36
Conclusion • All antipsychotics result in weight gain • Three risk groups – Limited: aripiprazol, amisulpride, ziprasidone – Moderate: haloperidol, risperidon, paliperidon, quetiapine – Severe: olanzapine & clozapine • Weight gain is not associated with diagnosis Department 37
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