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Meta-Analysis
. 2025 May 8;51(3):625-636.
doi: 10.1093/schbul/sbae173.

The Optimal Dosage and Duration of Metformin for Prevention and Treatment of Antipsychotic-Induced Weight Gain: An Updated Systematic Review and Meta-Analysis

Tzu-Rong Peng  1   2 , Jou-An Chen  2 , Jen-Ai Lee  2 , Chih-Pin Hsing  3 , Ming-Chia Lee  2   4   5 , Shih-Ming Chen  2
Affiliations
Meta-Analysis

The Optimal Dosage and Duration of Metformin for Prevention and Treatment of Antipsychotic-Induced Weight Gain: An Updated Systematic Review and Meta-Analysis

Tzu-Rong Peng et al. Schizophr Bull. .

Abstract

Background: Weight gain and metabolic complications are substantial adverse effects associated with second-generation antipsychotics. However, comprehensive guidelines for managing antipsychotic-induced weight gain are lacking.

Methods: This review included all double-blind, placebo-controlled studies investigating metformin's effectiveness in addressing antipsychotic-related weight gain. We systematically searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, Google Scholar, and ClinicalTrials.gov for relevant studies from the inception to 2024. A random-effects model was used for the meta-analysis.

Results: This meta-analysis, including 20 studies with 1070 patients, revealed that metformin significantly surpassed placebo in attenuating weight gain in patients receiving antipsychotics. The mean weight change with metformin was -3.32 kg [95% confidence interval (CI): -4.57 to -2.07]. Additionally, metformin use resulted in a marked decrease in body mass index [-1.24 kg/m2 (95% CI: -1.70 to -0.77)]. Metformin could maintain the effects from 12 to 24 weeks.

Conclusions: This updated meta-analysis investigated the durations and dosages of metformin use in patients with schizophrenia experiencing antipsychotic-induced weight gain. The findings highlight the need for additional large-scale research to validate our findings.

Keywords: antipsychotic-induced weight gain; meta-analysis; metformin.

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Conflict of interest statement

All authors declare that they have no competing interests.

Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses Flow Diagram for Study Selection
Figure 2.
Figure 2.
Forest Plot of Difference in Mean Weight Change for Metformin Versus Placebo
Figure 3.
Figure 3.
Forest Plot of Mean Change in BMI for Metformin Versus Placebo
Figure 4.
Figure 4.
Forest Plot of Mean Change in Fasting Blood Glucose Level for Metformin Versus Placebo
Figure 5.
Figure 5.
Forest Plot of Mean Change in the Insulin Resistance Index for Metformin Versus Placebo
See this image and copyright information in PMC

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