Metabolic effects and clinical outcomes of olanzapine in schizophrenia: A systematic review and meta-analysis.

OBJECTIVE

To evaluate the metabolic changes of patients with schizophrenia treated with olanzapine and analyze the correlation between the dosage of the drug, the blood concentration and the clinical response, so as to provide a reference for the clinical diagnosis and treatment.

METHODS

PubMed, web of science, Cochrane Library, MEDLINE databases were used to search for studies on olanzapine treatment in patients with schizophrenia, to extract changes in body weight, BMI, waist circumference, cholesterol, PANSS (The Positive and Negative Syndrome Scale), SAPS (The Positive Syndrome Scale), SANS (The Negative Syndrome Scale), BPRS (Brief Psychiatric Rating Scale), CGI (Clinical Global Impressions Ratings), and so on for meta-analysis, and to analyze the correlation of medication dose, blood concentration, and clinical response.

RESULTS

Twenty clinical trials (1839 participants, 1058 male and 781 female patients) were included in this meta-analysis. The results showed that patients receiving olanzapine had significant weight gain (WMD = 0.25, 95 % CI: 0.06-0.44) and no significant changes in HDL-C, LDL-C, triglycerides, or total cholesterol. They were significantly decreased in PANSS (WMD = -2.05, 95 % CI: -2.83, - 1.26), SAPS (WMD = -1.62, 95 % CI: -2.15, - 1.09), sans (WMD = -0.80, 95 % CI: -0.93, - 0.66), BPRS (WMD = -2.79, 95 % CI: -4.11, - 1.46), and CGI (WMD = -1.81, 95 % CI: -2.25, - 1.36). The dose of medication was positively associated with clinical response, with higher plasma concentrations at the recommended dose associated with better clinical outcomes (or = 2.91, 95 % CI: 1.36-6.27). When the body blood concentration is > 10 μg/L, the clinical response rate reaches about 80 %.

CONCLUSION

The clinic can make an individualized medication regimen based on adjusting the dosage of drugs based on the results of the detection of blood concentration in the body under the premise of avoiding metabolic side effects to ensure the maximization of efficacy.