Texas Tech University Health Science Center at Permian Basin, Midland, TX, USA.
Griffin Memorial Hospital-Oklahoma State University, Tulsa, OK, USA.
Child Psychiatry Hum Dev. 2024 Apr;55(2):479-487. doi: 10.1007/s10578-022-01424-6. Epub 2022 Sep 6.
To systematically review studies evaluating pharmacological treatment intervention of the atypical antipsychotic induced weight gain in the pediatric population and summarize the current evidence of the pharmacological treatment. According to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, we searched the various databases Medline, PubMed, PubMed central (PMC), CINAHL, and clinicaltrial.gov. until Jan 30th, 2022 for relevant clinical studies. Medical subject heading (MeSH) terms or keywords were used, "Body Weight," "Weight Gain," "Weight Loss," "Body Weight Maintenance," "Pediatric Obesity" in "Pediatrics," "Adolescent," "Child" in context of "Antipsychotic Agents" and "Drug Therapy," "Therapeutics," "Treatment Outcome," "Early Medical Intervention." We used the PICO algorithm for our search (Population, Intervention, Comparison, Outcomes, and Study Design) framework. The initial search included 746 articles, nine studies were ultimately selected in the final qualitative review. We included relevant clinical reviews, case series, and randomized clinical trials that evaluated pharmacological intervention for antipsychotic-induced weight gain in the pediatric population. Non-peer-reviewed, non-human, non-English languages article was excluded. Metformin is the most studied medication for antipsychotic-induced weight gain in children. Three studies have shown that adding Metformin to the antipsychotics can significantly reduce the body weight and body mass index with mild transient side effects. Other adjunct medications like topiramate, amantadine, betahistine, or melatonin vary greatly in mitigating weight with various side effects. Lifestyle modification is the first step in dealing with AIWG, but the result is inconsistent. Avoiding the use of antipsychotic in children is preferred. Adding an adjuvant medication to the antipsychotic could prevent or mitigate their negative metabolic effect on the body weight and body mass index. Metformin has the most evidence, topiramate, betahistine, amantadine, and melatonin is possible alternatives in the pediatric patient without changing their antipsychotic medication. Other viable options show some benefits but need further clinical studies to establish efficacy and safety.
系统地回顾评估抗精神病药引起的儿科人群体重增加的药物治疗干预的研究，并总结目前药物治疗的证据。根据系统评价和荟萃分析的首选报告项目 (PRISMA) 指南，我们搜索了各种数据库 Medline、PubMed、PubMed 中心 (PMC)、CINAHL 和 clinicaltrial.gov。截至 2022 年 1 月 30 日，以寻找相关的临床研究。使用医学主题词 (MeSH) 术语或关键词，“体重”、“体重增加”、“体重减轻”、“体重维持”、“儿科肥胖”在“儿科”、“青少年”、“儿童”上下文“抗精神病药物”和“药物治疗”、“治疗学”、“治疗结果”、“早期医学干预”。我们使用 PICO 算法进行搜索（人群、干预、比较、结果和研究设计）框架。最初的搜索包括 746 篇文章，最终在最终的定性审查中选择了 9 项研究。我们纳入了评估抗精神病药引起的儿科人群体重增加的药物干预的相关临床综述、病例系列和随机临床试验。排除了未经同行评审、非人类、非英语语言的文章。二甲双胍是研究最多的用于治疗儿童抗精神病药引起的体重增加的药物。三项研究表明，将二甲双胍添加到抗精神病药中可以显著减轻体重和体重指数，且副作用轻微短暂。其他辅助药物，如托吡酯、金刚烷胺、倍他司汀或褪黑素，在减轻体重方面差异很大，且副作用各异。生活方式改变是处理 AIWG 的第一步，但结果不一致。最好避免在儿童中使用抗精神病药。在抗精神病药中添加辅助药物可以预防或减轻其对体重和体重指数的代谢不良影响。二甲双胍的证据最多，托吡酯、倍他司汀、金刚烷胺和褪黑素是儿科患者在不改变抗精神病药治疗的情况下的可能替代药物。其他可行的选择显示出一些益处，但需要进一步的临床研究来确定疗效和安全性。
