精神药物转换后代谢参数的演变：一项纵向队列研究。

Evolutions of Metabolic Parameters Following Switches of Psychotropic Drugs: A Longitudinal Cohort Study.

机构信息

Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Prilly, Switzerland.

Center for Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Prilly, Switzerland.

出版信息

Schizophr Bull. 2023 Jan 3;49(1):24-33. doi: 10.1093/schbul/sbac133.

DOI:10.1093/schbul/sbac133

PMID:36156101

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9810014/

Abstract

BACKGROUND

Several psychotropic drugs can induce weight gain and metabolic alterations. The authors compared metabolic evolutions of patients switching versus continuing psychotropic treatments with different risk profiles.

METHODS

Patients either switched from a high- to a medium- (N = 36) or low-risk drug (N = 27), from a medium- to a low-risk drug (N = 71), or to a same-risk drug (N = 61). Controls were kept using either a high- (N = 35), medium- (N = 155), or low-risk drug (N = 47). The evolution over 2 years of weight and metabolic parameters was analyzed using linear mixed-effect models, also examining the influence of polygenic risk scores for body mass index (BMI) or BMI and psychiatric disorders.

STUDY RESULTS

High-, medium-, or low-risk controls gained on average 1.32%, 0.42%, and 0.36% more weight per month than patients switching from or within these risk categories (P < .001, P < .001, and P = .003, respectively). High-to-high or high-to-medium switches resulted in a greater weight increase than switching to lower-risk categories (+0.77% and + 0.39% respectively, P < .001). No difference was found between switching medium-to-medium and medium-to-low (P ≈ 1). Switching high-to-low resulted in 10% weight loss after 2 years, with the greatest loss occurring the first 6 months after the switch. Compared with high-risk controls, lower total cholesterol (-0.27 mmol/l, P = .043) in the high-to-low group, and lower glucose (-0.44 mmol/l, P = .032) and systolic blood pressure (-5.50 mmHg, P = .034) in the low-to-low group were found. Polygenic scores were not associated with weight changes in controls or after switching.

CONCLUSION

Psychotropic switches to a lower- or same-risk drug can attenuate weight gain, with only switching high to low resulting in weight loss.

摘要

背景

几种精神药物可引起体重增加和代谢改变。作者比较了具有不同风险特征的患者转换与继续使用精神药物的代谢变化。

方法

患者要么从高风险药物转换为中风险药物（N=36）或低风险药物（N=27），要么从中风险药物转换为低风险药物（N=71），要么转换为相同风险药物（N=61）。对照者继续使用高风险药物（N=35）、中风险药物（N=155）或低风险药物（N=47）。使用线性混合效应模型分析 2 年内体重和代谢参数的变化，还检查了体重指数（BMI）或 BMI 和精神障碍的多基因风险评分的影响。

研究结果

高、中、低风险对照组患者每月体重平均增加 1.32%、0.42%和 0.36%，而从这些风险类别转换或继续使用药物的患者则分别为（P<.001，P<.001 和 P=.003）。高-高或高-中转换比转换为低风险类别导致体重增加更多（分别增加 0.77%和 0.39%，P<.001）。中-中或中-低转换之间没有差异（P≈1）。高-低转换导致 2 年后体重减轻 10%，转换后前 6 个月体重减轻最大。与高风险对照组相比，高-低组总胆固醇（-0.27 mmol/L，P=.043）和低-低组葡萄糖（-0.44 mmol/L，P=.032）和收缩压（-5.50 mmHg，P=.034）较低。多基因评分与对照组或转换后的体重变化无关。