Antipsychotics result in more weight gain in antipsychotic naive patients than in patients after antipsychotic switch and weight gain is irrespective of psychiatric diagnosis: A meta-analysis

Abstract

Introduction: Antipsychotics are associated with bodyweight gain and metabolic disturbance. Previous meta-analyses were limited to mainly antipsychotic switch studies in patients with a diagnosis of schizophrenia or psychosis with short follow-up periods. The present meta-analysis aimed to analyse the impact of weight change in antipsychotic-naive and antipsychotics switch patients and whether body weight change depended on diagnosis.

Method: We performed a meta-analysis of clinical trials of antipsychotics that reported weight change, irrespective of psychiatric diagnosis. Outcome measure was body weight change. Studies were classified into antipsychotic-naive and antipsychotic-switch. Forest plots stratified by antipsychotic and the duration of antipsychotic use were generated and results were summarised in figures.

Results: In total, 404 articles were included for the quantitative synthesis. 58 articles were on antipsychotic naive patients. In the antipsychotic naive group, all antipsychotics resulted in body weight gain. In the antipsychotic switch group, most antipsychotics likewise resulted in bodyweight gain, with exception of amisulpride, aripiprazole and ziprasidone that showed no body weight gain or even some weight loss after switching antipsychotics. Diagnosis was not a discriminating factor of antipsychotic induced weight change.

Conclusion: Antipsychotic use resulted in substantial increase in body weight in antipsychotic-naive patients. In antipsychotic-switch patients the weight gain was mild and not present in amisulpride, aripiprazole and ziprasidone. In both groups, weight gain was irrespective of the psychiatric diagnosis.

Fig 1. PRISMA flow chart.

Fig 2. Mean change in body weight per AP per period of the AP-naive group.

The antipsychotics per period. Green indicates almost no weight gain or weight loss. Grey indicates weight increase between 1 and 5 kilograms and red indicates weight increase > 5 kilograms per period. After the antipsychotic between brackets is indicated period in weeks, number of studies (N) and number of patients (n) were reported.

Fig 3. Mean change in body weight per AP per period of the AP-switch group.

The antipsychotics per period. Green indicates almost no weight gain or weight loss. Grey indicates weight increase between 0 and 10 kg and red indicates weight increase > 10 kilograms per period. Black indicates placebo. After the antipsychotic between brackets is indicated period in weeks, number of studies (N) and number of patients (n).