Peng Tzu-Rong, Chen Jou-An, Lee Jen-Ai, Hsing Chih-Pin, Lee Ming-Chia, Chen Shih-Ming
Department of Pharmacy, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231016, Taiwan.
School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei 11031, Taiwan.
Schizophr Bull. 2025 May 8;51(3):625-636. doi: 10.1093/schbul/sbae173.
Weight gain and metabolic complications are substantial adverse effects associated with second-generation antipsychotics. However, comprehensive guidelines for managing antipsychotic-induced weight gain are lacking.
This review included all double-blind, placebo-controlled studies investigating metformin's effectiveness in addressing antipsychotic-related weight gain. We systematically searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, Google Scholar, and ClinicalTrials.gov for relevant studies from the inception to 2024. A random-effects model was used for the meta-analysis.
This meta-analysis, including 20 studies with 1070 patients, revealed that metformin significantly surpassed placebo in attenuating weight gain in patients receiving antipsychotics. The mean weight change with metformin was -3.32 kg [95% confidence interval (CI): -4.57 to -2.07]. Additionally, metformin use resulted in a marked decrease in body mass index [-1.24 kg/m2 (95% CI: -1.70 to -0.77)]. Metformin could maintain the effects from 12 to 24 weeks.
This updated meta-analysis investigated the durations and dosages of metformin use in patients with schizophrenia experiencing antipsychotic-induced weight gain. The findings highlight the need for additional large-scale research to validate our findings.
体重增加和代谢并发症是与第二代抗精神病药物相关的重大不良反应。然而，目前缺乏关于管理抗精神病药物所致体重增加的综合指南。
本综述纳入了所有调查二甲双胍治疗抗精神病药物相关体重增加有效性的双盲、安慰剂对照研究。我们系统检索了PubMed、Embase、Cochrane对照试验中央注册库、谷歌学术和ClinicalTrials.gov，以查找从研究起始至2024年的相关研究。采用随机效应模型进行荟萃分析。
这项荟萃分析纳入了20项研究，共1070例患者，结果显示二甲双胍在减轻接受抗精神病药物治疗患者的体重增加方面显著优于安慰剂。使用二甲双胍后的平均体重变化为-3.32 kg [95%置信区间（CI）：-4.57至-2.07]。此外，使用二甲双胍导致体重指数显著下降[-1.24 kg/m²（95% CI：-1.70至-0.77）]。二甲双胍可在12至24周内维持疗效。
这项更新的荟萃分析研究了二甲双胍在患有抗精神病药物所致体重增加的精神分裂症患者中的使用时长和剂量。研究结果凸显了需要开展更多大规模研究来验证我们的发现。
