Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Department of Biostatistics and Research Support, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands.
Acta Psychiatr Scand. 2019 Sep;140(3):283-290. doi: 10.1111/acps.13074. Epub 2019 Jul 19.
Antipsychotic-induced weight gain (AiWG) is a debilitating adverse effect of most antipsychotics. First-episode psychosis patients are particularly vulnerable to the detrimental consequences of AiWG. Amisulpride has good efficacy and tolerability. We here aimed to identify the phenotypic factors associated with amisulpride-induced weight gain in first-episode psychosis patients.
Data were collected from the Optimization of Treatment and Management of Schizophrenia in Europe trial. Multivariable regression models with various phenotypic variables (N = 305) were performed with absolute AiWG and clinically relevant AiWG (≥7% AiWG) as outcomes.
Four weeks of amisulpride treatment increased body weight from 69.7 to 72.4 kg (P < 0.001). In the regression model of absolute AiWG, unemployment (β = 0.94, P = 0.016), younger age (β = -0.07, P = 0.031) and absence of current comorbid major depression disorder (β = -1.61, P = 0.034) were positively associated with absolute AiWG. In the regression model of clinically relevant AiWG, unemployment (OR = 2.83, P = 0.001), schizophreniform disorder (OR = 2.00, P = 0.025) and low baseline weight (OR = 0.97, P = 0.032) increased the likelihood of clinically relevant AiWG.
Clinicians prescribing amisulpride should consider the relatively high susceptibility to AiWG in unemployed first-episode patients with psychosis, in particular young subjects with a diagnosis of schizophreniform disorder. We advise to carefully monitor these patients and, when needed, implement weight-reducing strategies.
抗精神病药引起的体重增加（AiWG）是大多数抗精神病药的一种使人虚弱的不良反应。首发精神病患者尤其容易受到 AiWG 不利后果的影响。氨磺必利具有良好的疗效和耐受性。我们旨在确定与首发精神病患者氨磺必利引起的体重增加相关的表型因素。
数据来自欧洲治疗和管理精神分裂症的优化试验。使用多变量回归模型，将各种表型变量（N=305）作为结果，与绝对 AiWG 和临床相关的 AiWG（≥7% AiWG）进行比较。
氨磺必利治疗 4 周后，体重从 69.7 公斤增加到 72.4 公斤（P<0.001）。在绝对 AiWG 的回归模型中，失业（β=0.94，P=0.016）、年龄较小（β=-0.07，P=0.031）和当前无共患主要抑郁症（β=-1.61，P=0.034）与绝对 AiWG 呈正相关。在临床相关 AiWG 的回归模型中，失业（OR=2.83，P=0.001）、分裂样障碍（OR=2.00，P=0.025）和基线体重较低（OR=0.97，P=0.032）增加了发生临床相关 AiWG 的可能性。
临床医生在给首发精神病患者开具氨磺必利时，应考虑失业患者，尤其是年轻的分裂样障碍患者，他们对 AiWG 的敏感性相对较高。我们建议仔细监测这些患者，并在需要时实施减肥策略。
