Brixner Diana I, Said Qayyim, Corey-Lisle Patricia K, Tuomari A Vickie, L'italien Gilbert J, Stockdale William, Oderda Gary M
Executive Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City, UT 84108, USA.
Ann Pharmacother. 2006 Apr;40(4):626-32. doi: 10.1345/aph.1G564. Epub 2006 Mar 28.
While second-generation antipsychotics (SGAs) have had benefits over earlier antipsychotic treatments, their use has been associated with reports of weight gain. Body mass index (BMI) has been studied in clinical trials with limited comparison between drugs.
To investigate the impact of each SGA on the risk of weight increase in an adult population.
Using a national electronic medical records database, a naturalistic impact of SGAs on BMI was evaluated. Patients (aged >/=18 y) receiving a prescription for an antipsychotic drug between January 1995 and March 2004 were identified. An adverse event was defined as at least a 7% increase in BMI from baseline within one year of antipsychotic prescription and a post-increase BMI of at least 25 kg/m(2).
A total of 9394 patients were identified, with 1514 cases of increased BMI after initial prescription. Risperidone (OR 1.39; 95% CI 1.16 to 1.66), quetiapine (OR 1.36; 95% CI 1.13 to 1.64), and olanzapine (OR 1.76; 95% CI 1.50 to 2.07) were significantly more likely to cause BMI increase compared with first-generation antipsychotics (FGAs). Aripiprazole (OR 0.72; 95% CI 0.36 to 1.46), ziprasidone (OR 0.68; 95% CI 0.39 to 1.18), and clozapine (OR 1.01; 95% CI 0.56 to 1.81) were less likely to induce weight gain compared with FGAs.
This study provides a foundation for understanding how SGAs impact weight gain in a naturalistic, as opposed to a clinical trial, setting and provides evidence that there are differential risks of weight gain between SGAs. Because of negative long-term health effects of weight gain, physicians need to take all factors into consideration when recommending pharmaceutical therapy for patients with severe mental illness.
虽然第二代抗精神病药物（SGA）较早期的抗精神病治疗有诸多益处，但其使用与体重增加的报道相关。在临床试验中对体重指数（BMI）进行了研究，但药物之间的比较有限。
调查每种SGA对成年人群体重增加风险的影响。
利用国家电子病历数据库，评估SGA对BMI的实际影响。确定1995年1月至2004年3月期间接受抗精神病药物处方的患者（年龄≥18岁）。不良事件定义为在抗精神病药物处方后一年内BMI较基线至少增加7%，且增加后的BMI至少为25kg/m²。
共确定9394例患者，初始处方后有1514例BMI增加。与第一代抗精神病药物（FGA）相比，利培酮（OR 1.39；95%CI 1.16至1.66）、喹硫平（OR 1.36；95%CI 1.13至1.64）和奥氮平（OR 1.76；95%CI 1.50至2.07）导致BMI增加的可能性显著更高。与FGA相比，阿立哌唑（OR 0.72；95%CI 0.36至1.46）、齐拉西酮（OR 0.68；95%CI 0.39至1.18）和氯氮平（OR 1.01；95%CI 0.56至1.81）导致体重增加的可能性较小。
本研究为理解SGA在实际环境（而非临床试验环境）中如何影响体重增加提供了基础，并提供了证据表明SGA之间体重增加的风险存在差异。由于体重增加对健康有长期负面影响，医生在为重度精神疾病患者推荐药物治疗时需要考虑所有因素。
