1 UCL Division of Psychiatry, University College London, UK.
2 Camden and Islington NHS Foundation Trust, London, UK.
J Psychopharmacol. 2018 Oct;32(10):1098-1103. doi: 10.1177/0269881118780011. Epub 2018 Jun 25.
Follow-up studies of weight gain related to antipsychotic treatment beyond a year are limited in number. We compared weight change in the three most commonly prescribed antipsychotics in a representative UK General Practice database.
We conducted a cohort study in United Kingdom primary care records of people newly prescribed olanzapine, quetiapine or risperidone. The primary outcome was weight in each six month period for two years after treatment initiation. Weight changes were compared using linear regression, adjusted for age, baseline weight and diagnosis.
N = 6338 people received olanzapine, 12,984 quetiapine and 6556 risperidone. Baseline weight was lowest for men treated with olanzapine (80.8 kg versus 83.5 kg quetiapine, 82.0 kg risperidone) and women treated with olanzapine (67.7 kg versus 71.5 kg quetiapine 68.4 kg risperidone. Weight gain occurred during treatment with all three drugs. Compared with risperidone mean weight gain was higher with olanzapine (adjusted co-efficient +1.24 kg (95% confidence interval: 0.69-1.79 kg per six months) for men and +0.77 kg (95% confidence interval: 0.29-1.24 kg) for women). Weight gain with quetiapine was lower in unadjusted models compared with risperidone, but this difference was not significant after adjustment.
Olanzapine is more commonly prescribed to people with lower weight. However, after accounting for baseline weight, age, sex and diagnosis, olanzapine is still associated with greater weight gain over two years than risperidone or quetiapine. Baseline weight does not ameliorate the risks of weight gain associated with antipsychotic medication. Weight gain should be assertively discussed and managed for people prescribed antipsychotics, especially olanzapine.
抗精神病药物治疗一年后与体重增加相关的随访研究数量有限。我们比较了在英国普通诊所数据库中三种最常开的抗精神病药物的体重变化。
我们对新处方奥氮平、喹硫平或利培酮的英国初级保健记录进行了队列研究。主要结果是治疗开始后两年内每六个月的体重。使用线性回归比较体重变化，调整年龄、基线体重和诊断。
共有 6338 人接受奥氮平治疗，12984 人接受喹硫平治疗，6556 人接受利培酮治疗。奥氮平治疗的男性（80.8 公斤比喹硫平 83.5 公斤，利培酮 82.0 公斤）和女性（67.7 公斤比喹硫平 71.5 公斤，利培酮 68.4 公斤）的基线体重最低。三种药物治疗期间均出现体重增加。与利培酮相比，奥氮平的平均体重增加更高（男性调整后的系数为+1.24 公斤（95%置信区间：每六个月 0.69-1.79 公斤），女性为+0.77 公斤（95%置信区间：每六个月 0.29-1.24 公斤））。未调整模型中，喹硫平与利培酮相比体重增加较低，但调整后差异无统计学意义。
奥氮平更常开给体重较低的人。然而，在考虑基线体重、年龄、性别和诊断后，奥氮平在两年内的体重增加仍比利培酮或喹硫平更大。基线体重并不能减轻抗精神病药物相关体重增加的风险。对于开抗精神病药物的患者，特别是奥氮平，应积极讨论和管理体重增加问题。
