Weight gain changes in patients with aripiprazole monotherapy compared with aripiprazole-antidepressant polypharmacy in an outpatient sample

Assessment of factors associated with antipsychotic-induced weight gain: A nationwide cohort study

BACKGROUND

The incidence of antipsychotic-induced weight gain (AIWG) is difficult to predict in real-world practice because various factors influence it. This study aimed to explore background and medication-related factors associated with weight gain in patients newly prescribed with antipsychotic medication.

METHODS

This nationwide, multicenter, prospective cohort study was conducted in Japan. The primary endpoint was the incidence of AIWG (≥7 % weight gain) over 12 months after initiation of antipsychotic treatment. Factors influencing AIWG incidence were assessed using Cox proportional hazards regression analysis stratified by facility characteristics.

RESULTS

Of the 865 enrolled participants, 262 developed AIWG. Compared with aripiprazole, clozapine and olanzapine were related to a higher AIWG incidence (hazard ratio [HR] = 2.17, 95 % confidence interval [CI] = 1.05-4.51; HR = 2.01, 95 % CI = 1.36-2.96, respectively), whereas blonanserin was related to a lower AIWG incidence (HR = 0.49, 95 % CI = 0.24-0.98). Furthermore, co-administration of antidepressants and mood stabilizers increased the AIWG incidence (HR = 1.94, 95 % CI = 1.35-2.77; HR = 1.47, 95 % CI = 1.07-2.01, respectively). The impact of concomitant medications on AIWG incidence varied by the pharmacological characteristics of the newly initiated antipsychotic, in addition to the type and duration of concomitant medications.

CONCLUSIONS

The findings of this study suggest that the risk of AIWG incidence may be estimated by assessing the type of concomitant medication and its duration of use, type of newly initiated antipsychotic, and background factors prior to initiation of antipsychotic treatment.

Effects of Long-Term Sertraline Use on Pediatric Growth and Development: The Sertraline Pediatric Registry for The Evaluation of Safety (SPRITES)

Objective: To describe the results of the Sertraline Pediatric Registry for The Evaluation of Safety (SPRITES) outcome measures of cognitive, emotional, and physical development following long-term treatment with sertraline (for up to 3 years) in children and adolescents aged 6-16 years. Methods: SPRITES was a long-term, multicenter, open-label, prospective observational study designed to compare physical and psychological development in pediatric patients exposed to sertraline (with or without psychotherapy) or psychotherapy alone in usual care settings. Data were summarized descriptively, and outcomes were evaluated using a marginal structural model. Results: Between April 2012 and September 2020, 941 patients across 44 U.S. sites participated in the study. At baseline, 695 participants were exposed to sertraline (physician prescribed) with or without psychotherapy, and 245 participants were exposed to psychotherapy alone. Of these, 432 participants (46.0%) completed the full 3-year study follow-up. No significant changes across time were found in standardized height, BRIEF (Behavior Rating Inventory of Executive Function), Trails B, and Tanner stage based on cumulative sertraline exposure or exposure since the last visit. Change in mean standardized weight across time was positively associated with both cumulative sertraline exposure (p = 0.02) and exposure since the last visit (p = 0.029). The mean changes from baseline across time in standardized weight were standard deviations of 0.02, 0.03, 0.16, and 0.17 at months 3, 6, 30, and 36, respectively. However, this finding was not observed in the mean change across time in standardized body mass index, which was not statistically significant. Conclusions: Results are consistent with normal development. Although a statistically significant finding for standardized weight was observed in comparative analyses, the magnitude of the change is small and observed at higher doses of sertraline only. No other significant differences were observed between the "sertraline" group and the "no pharmacological therapy" group on other primary outcome measures. ClinicalTrials.gov identifier: NCT01302080.

Effects of antidepressant and antipsychotic use on weight gain: A systematic review

Weight gain is an adverse effect of antidepressants and antipsychotics. This side effect can lead to numerous comorbidities and reduces life expectancy. The use of these drugs is increasing worldwide, and the weight gain produced by them represents a common clinical challenge. The goal of this systematic review was to evaluate the potential association of antidepressant and antipsychotic therapy with body weight gain in cohort studies. A search of cohort studies investigating the association between weight gain and the use of antidepressants and antipsychotics in individuals was conducted through the PubMed database from 1 January 2008 to 31 January 2019 following the PRISMA statement. We found 27 independent eligible cohort studies that included children (2-18 years old) and adult (18-103 years old) subjects. Most of the included studies showed a 5% weight gain in individuals using antidepressant therapy. However, Quetiapine, Haloperidol, Trifluoperazine, Risperidone, Aripiprazole, Olanzapine, and Clozapine increased body weight ≥7% from baseline, which is considered a clinically significant result. Weight loss was found in individuals treated with Bupropion. Further cohort studies with higher sample sizes and longer durations of treatment are needed to confirm our observations.

Clinical Use of Dopamine Modulators as Third-Generation Antipsychotic Agents

When dopamine was identified as a primary target for schizophrenia, the dopamine antagonists, now referred to as first-generation antipsychotics, were added to our pharmacopeia. In the 1990s, with the discovery of risperidone and clozapine, the mechanism of dopamine receptor antagonism was paired with serotonin receptor antagonism to give rise to second-generation antipsychotics. A decade later these mechanisms were further refined to selective dopamine receptors antagonism and serotonin receptors antagonism and agonism to create a modulation or stabilization of dopamine nerve firing in differential ways. This new wave may be referred to as the third generation. The current article reviews the pharmacodynamics and pharmacokinetics of these dopamine modulators. [Journal of Psychosocial Nursing and Mental Health Services, 57(2), 7-11.].

Does the Time of Drug Administration Alter the Metabolic Risk of Aripiprazole?

Antipsychotic drugs cause metabolic abnormalities through a mechanism that involves antagonism of D₂ dopamine receptors (D₂R). Under healthy conditions, insulin release follows a circadian rhythm and is low at night, and in pancreatic beta-cells, D₂Rs negatively regulate insulin release. Since they are sedating, many antipsychotics are dosed at night. However, the resulting reduction in overnight D₂R activity may disrupt 24 h rhythms in insulin release, potentially exacerbating metabolic dysfunction. We examined retrospective clinical data from patients treated over approximately 1 year with the antipsychotic drug aripiprazole (ARPZ), a D2R partial agonist. To identify effects of timing on metabolic risk, we found cases treated with ARPZ either in the morning (n = 90) or at bedtime (n = 53), and compared hemoglobin A1c, and six secondary metabolic parameters across the two groups. After controlling for demographic and clinical factors, patients treated with ARPZ at night had a significant decrease in HDL cholesterol, while in patients who took ARPZ in the morning had no change. There was a non-significant trend toward higher serum triglycerides in the patients treated with ARPZ at night vs. morning. There were no group differences in hemoglobin A1c, BMI, total cholesterol, LDL cholesterol, or blood pressure. Patients taking APPZ at night developed a worse lipid profile, with lower HDL cholesterol and a trend toward higher triglycerides. These changes may pose additional metabolic risk factors compared to those who take ARPZ in the morning. Interventions based on drug timing may reduce some of the adverse metabolic consequences of antipsychotic drugs.