Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston.
Department of Industrial Engineering, College of Engineering, University of Houston, Houston.
J Clin Psychopharmacol. 2024;44(2):124-132. doi: 10.1097/JCP.0000000000001814. Epub 2024 Jan 23.
PURPOSE/BACKGROUND: Antipsychotic-associated weight gain (AAWG) is a common adverse effect of second-generation antipsychotic (SGA) medications among children and adolescents. This study applied group-based trajectory modeling to identify latent trajectories of AAWG among children and adolescents and associated risk factors.
This was a retrospective analysis of the IQVIA Ambulatory EMR-US database from 2016 to 2021. The cohort consisted of patients aged 6 to 19 years who were SGA naive and received at least 90 days of continuous SGA prescriptions. Group-based trajectory modeling was used to identify latent trajectories of AAWG development during a 24-month period since SGA initiation, and multinomial logistic regression analysis was conducted to examine the risk factors associated with the identified AAWG trajectories.
FINDINGS/RESULTS: A total of 16,262 patients were included. Group-based trajectory modeling identified the following 4 distinctive AAWG trajectories: persistent severe weight gain (4.2%), persistent moderate weight gain (20.1%), minor weight change (69.6%), and gradual weight loss (6.1%). Compared with the minor weight change group, younger age (12-17 vs 5-11: odds ratio [OR], 0.634; 95% confidence interval [CI], 0.521-0.771), lower baseline body mass index z -score (OR, 0.216; 95% CI, 0.198-0.236), and receiving olanzapine as the initial SGA (olanzapine vs aripiprazole: OR, 1.686; 95% CI, 1.673-1.699) were more likely to follow severe weight gain trajectories. The area under the receiver operating characteristic curves for comparing severe weight gain versus minor weight change groups and moderate weight vs minor weight change groups in the multinomial regression model were 0.91 and 0.8, respectively.
IMPLICATIONS/CONCLUSIONS: A quarter of pediatric SGA recipients experienced persistent weight gain during the SGA treatment. The risk of having persistent AAWG can be predicted using patient characteristics collected before SGA initiation and the initial SGA agent.
目的/背景：第二代抗精神病药物（SGA）引起的体重增加（AAWG）是儿童和青少年中常见的不良反应。本研究应用基于群组的轨迹建模来识别儿童和青少年中 AAWG 的潜在轨迹及其相关风险因素。
这是对 2016 年至 2021 年 IQVIA 门诊电子病历-美国数据库的回顾性分析。该队列由年龄在 6 至 19 岁的 SGA 初治患者组成，他们至少接受了 90 天的连续 SGA 处方。使用基于群组的轨迹建模来识别 SGA 起始后 24 个月内 AAWG 发展的潜在轨迹，并进行多项逻辑回归分析以检验与确定的 AAWG 轨迹相关的风险因素。
结果/发现：共纳入 16262 名患者。基于群组的轨迹建模确定了以下 4 种不同的 AAWG 轨迹：持续性严重体重增加（4.2%）、持续性中度体重增加（20.1%）、轻度体重变化（69.6%）和逐渐体重减轻（6.1%）。与轻度体重变化组相比，年龄较小（12-17 岁与 5-11 岁：比值比 [OR]，0.634；95%置信区间 [CI]，0.521-0.771）、较低的基线体重指数 z 评分（OR，0.216；95%CI，0.198-0.236）和初始 SGA 接受奥氮平（奥氮平与阿立哌唑：OR，1.686；95%CI，1.673-1.699）更有可能遵循严重体重增加轨迹。多项回归模型中，严重体重增加组与轻度体重变化组、中度体重增加组与轻度体重变化组之间比较的受试者工作特征曲线下面积分别为 0.91 和 0.8。
意义/结论：四分之一的儿科 SGA 接受者在 SGA 治疗期间出现持续体重增加。使用 SGA 起始前收集的患者特征和初始 SGA 药物可以预测持续性 AAWG 的风险。
