Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, Texas, USA.
School of Public Health, The University of Texas at Houston, Houston, Texas, USA.
J Child Adolesc Psychopharmacol. 2024 May;34(4):201-209. doi: 10.1089/cap.2023.0071. Epub 2024 Feb 26.
As many as 60% of pediatric patients taking second-generation antipsychotics (SGA) experience weight gain (antipsychotic-induced weight gain). However, the subgroup that experienced substantial weight increase was poorly understood. This study aimed to identify the development and predictors of clinically significant weight gain (CSWG) among pediatric SGA recipients. A retrospective analysis of the 2016 to 2021 IQVIA Ambulatory EMR-US database was conducted. The study cohort comprised SGA-naive patients ages 5 to 19, continuously prescribed SGA for ≥90 days. CSWG was defined as a weight gain in BMI -score >0.5. The development of CSWG was described using the group-based trajectory model approach, and multinomial logistic regression analysis was conducted to examine the risk factors associated with the CSWG trajectories. Of the 16,262 SGA recipients who met the inclusion criteria, 4 distinctive CSWG trajectories were identified: (1) Rapid (14.6%), (2) Gradual (12.6%), (3) Transit (7%), and (4) no CSWG (65.8%). Factors associated with a higher likelihood of having rapid or gradual CSWG versus nonsignificant weight gain were being younger (OR [95% CI] = 12-17 vs. 5-11, Rapid, 0.727 [0.655-0.806]; Gradual, 0.776 [0.668-0.903]), male (Rapid, 1.131 [1.021-1.253]), non-Hispanic White (Black vs. White: Rapid, 0.833 [0.709-0.98]), with lower baseline BMI -score (Rapid, 0.376 [0.361-0.392]; Gradual, 0.449 [0.424-0.476]), and receiving olanzapine as the initial SGA (Rapid, 1.38 [1.093-1.74]). The Area under the Receiver operating characteristic (ROC) Curve for the comparison of rapid and gradual CSWG with no CSWG trajectory were 0.83 and 0.80, respectively. SGA recipients experienced four distinctive CSWG trajectories (Rapid, Gradual, Transient, and No CSWG). The risk of CSWG could be predicted using patient characteristics at the SGA initiation. This insight highlights the importance of personalized monitoring and timely intervention strategies for at-risk individuals who experienced persistent CSWG in real practice.
多达 60%的服用第二代抗精神病药物（SGA）的儿科患者会出现体重增加（抗精神病药引起的体重增加）。然而，对于体重显著增加的亚组，人们的了解甚少。本研究旨在确定儿科 SGA 接受者中临床显著体重增加（CSWG）的发展和预测因素。 对 2016 年至 2021 年 IQVIA 门诊 EMR-US 数据库进行了回顾性分析。研究队列包括年龄在 5 至 19 岁之间、持续服用 SGA 治疗 ≥90 天的 SGA 初治患者。CSWG 定义为 BMI 评分中体重增加>0.5。使用基于群组的轨迹模型方法描述 CSWG 的发展，并进行多项逻辑回归分析以检查与 CSWG 轨迹相关的风险因素。 在符合纳入标准的 16262 名 SGA 接受者中，确定了 4 种不同的 CSWG 轨迹：（1）快速（14.6%），（2）渐进（12.6%），（3）过渡（7%）和（4）无 CSWG（65.8%）。与无显著体重增加相比，与快速或渐进 CSWG 相关的更高可能性的因素是年龄较小（OR [95%CI] = 12-17 比 5-11，快速，0.727 [0.655-0.806]；渐进，0.776 [0.668-0.903]），男性（快速，1.131 [1.021-1.253]），非西班牙裔白人（黑人比白人：快速，0.833 [0.709-0.98]），基线 BMI 评分较低（快速，0.376 [0.361-0.392]；渐进，0.449 [0.424-0.476]），以及最初接受奥氮平作为 SGA（快速，1.38 [1.093-1.74]）。快速和渐进 CSWG 与无 CSWG 轨迹比较的接收器操作特征（ROC）曲线下面积分别为 0.83 和 0.80。 SGA 接受者经历了四种不同的 CSWG 轨迹（快速、渐进、过渡和无 CSWG）。使用 SGA 启动时的患者特征可以预测 CSWG 的风险。这一见解突出了在真实实践中对持续发生 CSWG 的高危个体进行个性化监测和及时干预策略的重要性。
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