De Riddhita, Smith Emily C C, Navagnanavel Janani, Au Emily, Maksyutynska Kateryna, Papoulias Maria, Singh Raghunath, Panganiban Kristoffer J, Humber Bailey, Mohr Grimur Høgnason, Nielsen Mette Ødegaard, Ebdrup Bjørn H, Remington Gary, Agarwal Sri Mahavir, Hahn Margaret K
Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.
Institute of Medical Science, University of Toronto, Toronto, Canada.
Acta Psychiatr Scand. 2025 Feb;151(2):109-126. doi: 10.1111/acps.13758. Epub 2024 Sep 17.
Nonadherence/discontinuation of antipsychotic (AP) medications represents an important clinical issue in patients across psychiatric disorders, including schizophrenia spectrum disorders (SSDs). While antipsychotic-induced weight gain (AIWG) is a reported contributor to nonadherence, a systematic review of the association between AIWG and medication nonadherence/discontinuation has not been explored previously.
A systematic search was conducted in MEDLINE, EMBASE, PsychINFO, CINAHL, and CENTRAL databases, among others, to help identify all studies which explored adherence, study dropouts, AP switching and/or discontinuations attributable to AIWG among individuals with severe mental illness. A meta-analysis was also completed where applicable.
We identified two categories of studies for the meta-analysis. Category 1 included three studies, which compared measures of AP adherence or discontinuation across BMI classes/degrees of self-reported weight gain. When compared to normal weight individuals receiving APs or those who did not report AIWG, individuals who were either overweight or obese or reported weight gain in relation to AP use had an increased odds of AP nonadherence (OR 2.37; 95% CI 1.51-3.73; p = 0.0002). Category 2 had 14 studies which compared measures of discontinuation related to weight gain reported as an adverse effect across different APs. Olanzapine was associated with a 3.32 times (95% CI 2.32-4.74; p < 0.00001) increased likelihood of nonadherence or discontinuation when compared to other APs with lower weight gain liabilities. Similarly, APs with moderate weight gain liability (paliperidone, risperidone, and quetiapine) increased the odds of nonadherence or discontinuation by 2.25 (95% CI 1.31-3.87; p = 0.003) when compared to APs considered to have lower weight gain liability (i.e. haloperidol and aripiprazole). The qualitative summary also confirmed these findings.
This review and meta-analysis suggests that AIWG influences medication nonadherence/discontinuation, whereby APs with higher weight gain liability are associated with nonadherence/discontinuation. Additional studies are needed to confirm these findings.
抗精神病药物（AP）的不依从/停药是包括精神分裂症谱系障碍（SSD）在内的各类精神疾病患者面临的一个重要临床问题。虽然抗精神病药物所致体重增加（AIWG）被认为是导致不依从的一个因素，但此前尚未对AIWG与药物不依从/停药之间的关联进行系统综述。
在MEDLINE、EMBASE、PsychINFO、CINAHL和CENTRAL等数据库中进行系统检索，以找出所有探讨严重精神疾病患者中因AIWG导致的依从性、研究退出、AP换药和/或停药情况的研究。在适用的情况下还完成了荟萃分析。
我们确定了两类用于荟萃分析的研究。第1类包括3项研究，这些研究比较了不同BMI类别/自我报告体重增加程度的AP依从性或停药情况。与接受AP治疗的正常体重个体或未报告AIWG的个体相比，超重或肥胖个体或报告因使用AP而体重增加的个体出现AP不依从的几率更高（比值比2.37；95%置信区间1.51 - 3.73；p = 0.0002）。第2类有14项研究，这些研究比较了不同AP作为不良反应报告的与体重增加相关的停药情况。与体重增加可能性较低的其他AP相比，奥氮平导致不依从或停药的可能性增加3.32倍（95%置信区间2.32 - 4.74；p < 0.00001）。同样，与被认为体重增加可能性较低的AP（即氟哌啶醇和阿立哌唑）相比，体重增加可能性中等的AP（帕利哌酮、利培酮和喹硫平）导致不依从或停药的几率增加2.25倍（95%置信区间1.31 - 3.87；p = 0.003）。定性总结也证实了这些发现。
本综述和荟萃分析表明，AIWG会影响药物不依从/停药，即体重增加可能性较高的AP与不依从/停药相关。需要更多研究来证实这些发现。
