본문 바로가기
KERD
논문KCI 등재

조현병 및 조현정동장애 환자에서 항정신병약물에 의한 체중증가에 미치는 메트포르민의 영향: 체계적 문헌고찰 및 메타분석

The Effect of Metformin on Antipsychotic-induced Weight Gain in Patients with Schizophrenia or Schizoaffective Disorder: A Systematic Review and Meta-analysis of Randomized Placebo-Controlled Trials

1

조회

0

다운로드

0

인용

0

참고문헌

키워드

주제분류약학

초록

Background: In this systematic review and meta-analysis, the effect of metformin on weight loss was assessed to determinewhether metformin should be recommended for the prevention or treatment of weight gain in patients receiving antipsychoticmedication for the treatment of schizophrenia or schizoaffective disorder. Methods: The PubMed, Embase, and Cochrane Librarydatabases were searched for all published randomized controlled trials (RCTs) from inception to June 2018. In addition, thereferences of relevant articles were also examined. Using Review Manager 5, the pooled estimates of the weighted mean difference(WMD) of the changes in body weight and body mass index (BMI) and the corresponding 95 % confidence intervals (CIs) werecalculated. Results: The meta-analysis included 15 RCTs. The pooled analysis showed that compared with placebo, metformin ledto significant reductions in body weight (WMD: -2.09, 95% CI: -2.59, -1.60; p<0.00001) and BMI (WMD: -0.90, 95% CI: -1.08, -0.72; p<0.00001). The effect of metformin on weight loss was greater in patients receiving olanzapine than in patients receivingclozapine (body weight, WMD: -2.39, 95% CI: -3.76, -1.02; p=0.0006 for olanzapine; -1.99, 95% C: -3.47, -0.51; p=0.009 forclozapine; BMI, WMD: -1.15, 95% CI: -1.74, -0.57, p=0.0001 for olanzapine; WMD: 0.76, 95% CI: -1.23, -0.28; p=0.002 forclozapine). Conclusion: Metformin can be recommended to manage olanzapine-induced weight gain in patients with schizophreniaor schizoaffective disorder. The magnitude of the reductionss in body weight and BMI implieds that the use of metformin toattenuate olanzapine-induced weight gain can minimize the risk of coronary heart disease.

Abstract

Background: In this systematic review and meta-analysis, the effect of metformin on weight loss was assessed to determinewhether metformin should be recommended for the prevention or treatment of weight gain in patients receiving antipsychoticmedication for the treatment of schizophrenia or schizoaffective disorder. Methods: The PubMed, Embase, and Cochrane Librarydatabases were searched for all published randomized controlled trials (RCTs) from inception to June 2018. In addition, thereferences of relevant articles were also examined. Using Review Manager 5, the pooled estimates of the weighted mean difference(WMD) of the changes in body weight and body mass index (BMI) and the corresponding 95 % confidence intervals (CIs) werecalculated. Results: The meta-analysis included 15 RCTs. The pooled analysis showed that compared with placebo, metformin ledto significant reductions in body weight (WMD: -2.09, 95% CI: -2.59, -1.60; p<0.00001) and BMI (WMD: -0.90, 95% CI: -1.08, -0.72; p<0.00001). The effect of metformin on weight loss was greater in patients receiving olanzapine than in patients receivingclozapine (body weight, WMD: -2.39, 95% CI: -3.76, -1.02; p=0.0006 for olanzapine; -1.99, 95% C: -3.47, -0.51; p=0.009 forclozapine; BMI, WMD: -1.15, 95% CI: -1.74, -0.57, p=0.0001 for olanzapine; WMD: 0.76, 95% CI: -1.23, -0.28; p=0.002 forclozapine). Conclusion: Metformin can be recommended to manage olanzapine-induced weight gain in patients with schizophreniaor schizoaffective disorder. The magnitude of the reductionss in body weight and BMI implieds that the use of metformin toattenuate olanzapine-induced weight gain can minimize the risk of coronary heart disease.

참고문헌 (42)

  1. American Psychiatric Association, "DSM-5 Task Force. Diagnostic and statistical manual of mental disorders: DSM-5™" (2013), American Psychiatric Publishing, Inc
  2. Crismon M. L, "Pharmacotherapy: a pathophysiologic approach", pp.1022~1028 (2013), McGraw-Hill Education
  3. "BIT Druginfo"[URL]
  4. Hasan A, "World Federation of Societies of Biological Psychiatry(WFSBP) guidelines for the biological treatment of schizophrenia. Part 3: Update 2015 management of special circumstances: depression, suicidality, substance use disorders and pregnancy and lactation 2015", Send to World J Biol Psychiatry, 16, pp.142~170 (2015)
  5. Lieberman JA, "Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Investigators. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia", N Engl J Med, 353(12), pp.1209~1223 (2005)[DOI]
  6. McEvoy JP, "CATIE Investigators. Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment", Am J Psychiatry, 163(4), pp.600~610 (2006)[DOI]
  7. Baptista T, "Body weight gain induced by antipsychotic drugs: mechanisms and management", Acta Psychiatr Scand, 100(1), pp.3~16 (1999)[DOI]
  8. Hasnain M, "Metformin for atypical antipsychotic-induced weight gain and glucose metabolism dysregulation: review of the literature and clinical suggestions", CNS Drugs, 24(3), pp.193~206 (2010)[DOI]
  9. Pringsheim T, "Physical Health and Drug Safety in Individuals with Schizophrenia", Can J Psychiatry, 62(9), pp.673~683 (2017)[DOI]
  10. Management of schizophrenia. SIGN Publication 131, "Scottish Intercollegiate Guidelines Network", SIGN, ~ (2013)
  11. Chamberlain JJ, "Pharmacologic therapy for type 2 diabetes: Synopsis of the 2017 American Diabetes Association Standards of Medical Care in Diabetes", Ann Intern Med, 166(8), pp.572~578 (2017)[DOI]
  12. Professional Practice Committee, "Standards of Medical Care in Diabetes-2018", Diabetes Care, 41(Suppl 1), pp.S3~ (2018)[DOI]
  13. Klip A, "Cellular mechanism of action of metformin", Diabetes Care, 13(6), pp.696~704 (1990)[DOI]
  14. Schultes B, "Modulation of hunger by plasma glucose and metformin", J Clin Endocrinol Metab, 88(3), pp.1133~1141 (2003)[DOI]
  15. Seifarth C, "Effectiveness of metformin on weight loss in non-diabetic individuals with obesity", Exp Clin Endocri- nol Diabetes, 121(1), pp.27~31 (2013)
  16. Kusaka I, "Metformin, but not pioglitazone, decreases postchallenge plasma ghrelin levels in type 2 diabetic patients: a possible role in weight stability?", Diabetes Obes Metab, 10(11), pp.1039~1046 (2008)[DOI]
  17. Aubert G, "The anorexigenic effects of metformin involve increases in hypothalamic leptin receptor expression", Metabolism, 60(3), pp.327~334 (2011)[DOI]
  18. Malin SK, "Effects of metformin on weight loss: potential mechanisms", Curr Opin Endocrinol Diabetes Obes, 21(5), pp.323~329 (2014)[DOI]
  19. Zheng W, "Metformin for Weight Gain and Metabolic Abnormalities Associated With Antipsychotic Treatment: Meta-Analysis of Randomized Placebo-Controlled Trials", J Clin Psychopharmacol, 35(5), pp.499~509 (2015)[DOI]
  20. "Assessing risk of bias in included studies;Cochrane handbook for systematic reviews of interventions. Version 5.1.0"[URL]
  21. Xuan C, "No association between APOE <TEX>${\varepsilon}$<", TEX> 4 allele and multiple sclerosis susceptibility: a meta-analysis from 5472 cases and 4727 controls, 2011, pp.308(1-2), 110~116
  22. 최윤영, "제 2형 당뇨 환자에서 자가혈당측정의 임상적 유용성 : 체계적문헌고찰 및 메타분석", 한국임상약학회지, 20(3), pp.183~192 (2010), 한국임상약학회
  23. Baptista T, "Metformin for prevention of weight gain and insulin resistance with olanzapine: a double-blind placebo-controlled trial", Can J Psychiatry, 51(3), pp.192~196 (2006)[DOI]
  24. Klein DJ, "A randomized, doubleblind, placebo-controlled trial of metformin treatment of weight gain associated with initiation of atypical antipsychotic therapy in children and adolescents", Am J Psychiatry, 163(12), pp.2072~2079 (2006)[DOI]
  25. Baptista T, "Metformin as an adjunctive treatment to control body weight and metabolic dysfunction during olanzapine administration: a multicentric, double-blind, placebo-controlled trial", Schizophr Res, 93(1-3), pp.99~108 (2007)[DOI]
  26. Arman S, "A randomized, double-blind, placebo-controlled trial of metformin treatment for weight gain associated with initiation of risperidone in children and adolescents", Saudi Med J, 29(8), pp.1130~1134 (2008)
  27. Wu RR, "Metformin addition attenuates olanzapine-induced weight gain in drug-naive first-episode schizophrenia patients: a double-blind, placebo-controlled study", Am J Psychiatry, 165(3), pp.352~358 (2008)[DOI]
  28. Carrizo E, "Extended release metformin for metabolic control assistance during prolonged clozapine administration: a 14 week, double-blind, parallel group, placebo-controlled study", Schizophr Res, 113(1), pp.19~26 (2009)[DOI]
  29. Tao F, "Efficacy of metformin for treatment of olanzapine-induced weight gain in patients with first-episode schizophrenia", Xiandai Shiyong Yixue, 24, pp.58~59 (2012)
  30. Wang M, "Metformin for treatment of antipsychotic-induced weight gain: a randomized, placebo-controlled study", Schizophr Res, 138(1), pp.54~57 (2012)[DOI]
  31. Chen CH, "Effects of adjunctive metformin on metabolic traits in nondiabetic clozapine-treated patients with schizophrenia and the effect of metformin discontinuation on body weight: a 24-week, randomized, double-blind, placebo-controlled study", J Clin Psychiatry, 74(5), pp.e424~e430 (2013)[DOI]
  32. Jarskog LF, "Metformin for weight loss and metabolic control in overweight outpatients with schizophrenia and schizoaffective disorder", Am J Psychiatry, 170(9), pp.1032~1040 (2013)[DOI]
  33. de Silva VA, "Metformin for treatment of antipsychotic-induced weight gain in a South Asian population with schizophrenia or schizoaffective disorder: A double blind, randomized, placebo controlled study", J Psychopharmacol, 29(12), pp.1255~1261 (2015)[DOI]
  34. Hebrani P, "Double-blind, randomized, clinical trial of metformin as add-on treatment with clozapine in treatment of schizophrenia disorder", J Res Med Sci, 20(4), pp.364~371 (2015)
  35. Chiu CC, "Effects of Low Dose Metformin on Metabolic Traits in Clozapine-Treated Schizophrenia Patients: An Exploratory Twelve-Week Randomized, Double-Blind, Placebo-Controlled Study", PLoS One, 11(12), pp.e0168347~ (2016)[DOI]
  36. Rado J, "A Naturalistic Randomized Placebo-Controlled Trial of Extended-Release Metformin to Prevent Weight Gain Associated With Olanzapine in a US Community-Dwelling Population", J Clin Psychopharmacol, 36(2), pp.163~168 (2016)[DOI]
  37. Wu RR, "Metformin treatment of antipsychotic-induced dyslipidemia: an analysis of two randomized, placebocontrolled trials", Mol Psychiatry, 21(11), pp.1537~1544 (2016)[DOI]
  38. "Overweight & Obesity"[URL]
  39. St Jeor ST, "A classification system to evaluate weight maintainers, gainers, and losers", J Am Diet Assoc, 97(5), pp.481~488 (1997)[DOI]
  40. Anderson JW, "Obesity and disease management: effects of weight loss on comorbid conditions", Obes Res, 9(Suppl 4), pp.326S~334S (2001)[DOI]
  41. Korean Academy of Medical Sciences, "Evidence-based Recommendations for Hypertension in Primary Care 2014"
  42. Brown JD, "Effects on cardiovascular risk factors of weight losses limited to 5-10", Transl Behav Med, 6(3), pp.339~346 (2016)[DOI]

관련 논문AI추천

Metformin Attenuates Liver Fat Content: Finding from Schizophrenia Patients with Olanzapine-induced Weight GainLe-ping Xu, Li Wang, Ning Li, Xing-qi Tan, Yu Chen, Yun-chuan Sui, Zhi Zhou대한정신약물학회 · Clinical Psychopharmacology and Neuroscience2020 · 제18권 제1호일 정신병원에 입원한 조현병 환자의 대사지표와 관련된 비정형 항정신병약물 요인견영기, 김지완, 박종익, 이준영대한생물치료정신의학회 · 생물치료정신의학2017 · 제23권 제2호항정신병약물을 처음으로 사용하는 초발 정신증 환자에서 나타나는 체중 및 대사성 지표의 변화 : 후향적 연구강제욱, 공보금, 김민걸, 김성진, 김우진, 김정은, 김현정, 문정준, 박민경, 심주철, 정도운대한생물치료정신의학회 · 생물치료정신의학2011 · 제17권 제2호Does Melatonin and Melatonin Agonists Improve the Metabolic Side Effects of Atypical Antipsychotics?: A Systematic Review and Meta-analysis of Randomized Controlled TrialsFrancesco Brigo, Stanley C. Igwe대한정신약물학회 · Clinical Psychopharmacology and Neuroscience2018 · 제16권 제3호조현병 환자에서 비전형항정신병약물 사용시 대사지표에 미치는 영향 조사 : 3년 추적연구박은경, 배하현, 윤해주, 이종일대한조현병학회 · 대한조현병학회지2017 · 제20권 제1호조현병 환자에서 항정신약물이 대사지표에 미치는 영향 조사 - 1년 추적연구박은경, 윤해주, 이종일, 임선진, 정선화대한조현병학회 · 대한조현병학회지2015 · 제18권 제2호

이 간행물의 다른 논문 (11건)