Per Bee Leng, Loeser Susan, Edwards Suzanne, Lee Wen Siew, Wilton Lisa R, Clark Scott Richard
Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
SA Pharmacy, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
Acta Psychiatr Scand. 2025 Mar 11;151(6):719-30. doi: 10.1111/acps.13796.
Metformin shows potential in combating clozapine-induced weight gain (CIWG). However, current evidence for its use remains limited. Through an audit we determined the prevalence of metformin use among clozapine-treated patients and its impact on weight and waist circumference (WC).
This retrospective cohort study examined electronic medical records of community-based clozapine patients under the care of metropolitan community mental health teams within the Central Adelaide Local Health Network (CALHN) from January 2014 to June 2023. We included patients treated with clozapine both with and without metformin, above 18 years of age, with complete physical monitoring data at baseline, 6, and 12 months.
There were 357 patients, who met study criteria. Metformin was prescribed to 23% of patients, of whom 78% had diabetes. At baseline, WC was > 101 cm in 71% of males and > 87 cm in 86% of females, placing them at increased risk of weight-related comorbidities, including cardiovascular disease, cancer, and death. After 1 year, males and females in the highest risk group for WC-related comorbidities increased to 76.3% and 95.4%, respectively. Co-prescription of metformin with clozapine was associated with unadjusted mean weight loss (-1.67 kg) and decrease in WC (-1.00 cm). Patients not using metformin gained weight (0.68 kg) and WC (2.49 cm). Using a linear mixed-effects models adjusting for repeated measurements, age, sex, and type 2 diabetes, over 12 months, patients treated with metformin were 3.08 kg lighter than those not taking metformin (95% confidence interval [CI]: 0.54-5.62, p = 0.018). Similar models suggested patients treated with metformin showed an average 2.83 cm decrease in WC compared with those not taking metformin (CI: 0.26-5.40, p = 0.03). There was no significant interaction between difference from baseline in weight or WC and metformin dose (p > 0.05).
DISCUSSION/CONCLUSION: The prevalence of metformin use for CIWG appears low in this cohort, where over 84% of patients were overweight or obese. Metformin use was associated with a significantly lower incidence of weight and WC gain over 12 months. Pharmacists are crucial for educating clinicians and patients about the benefits of metformin for reducing CIWG.
二甲双胍在对抗氯氮平所致体重增加（CIWG）方面显示出潜力。然而，目前其使用的证据仍然有限。通过一项审计，我们确定了氯氮平治疗患者中二甲双胍的使用 prevalence 及其对体重和腰围（WC）的影响。
这项回顾性队列研究检查了2014年1月至2023年6月期间阿德莱德中央地方卫生网络（CALHN）内大都市社区心理健康团队所护理的社区氯氮平患者的电子病历。我们纳入了年龄在18岁以上、在基线、6个月和12个月时有完整身体监测数据的接受氯氮平和未接受氯氮平治疗的患者。
有357名患者符合研究标准。23%的患者被处方了二甲双胍，其中78%患有糖尿病。在基线时，71%的男性腰围>101厘米，86%的女性腰围>87厘米，这使他们面临与体重相关的合并症（包括心血管疾病、癌症和死亡）风险增加。1年后，与WC相关合并症风险最高组的男性和女性分别增至76.3%和95.4%。二甲双胍与氯氮平联合处方与未调整的平均体重减轻（-1.67千克）和WC减少（-1.00厘米）相关。未使用二甲双胍的患者体重增加（0.68千克）和WC增加（2.49厘米）。使用线性混合效应模型对重复测量、年龄、性别和2型糖尿病进行调整后，在12个月内，接受二甲双胍治疗的患者比未服用二甲双胍的患者轻3.08千克（95%置信区间[CI]：0.54 - 5.62，p = 0.018）。类似模型表明，与未服用二甲双胍的患者相比，接受二甲双胍治疗的患者WC平均减少2.83厘米（CI：0.26 - 5.40，p = 0.03）。体重或WC与基线差异和二甲双胍剂量之间没有显著交互作用（p > 0.05）。
讨论/结论：在这个队列中，用于CIWG的二甲双胍使用率似乎较低，其中超过84%的患者超重或肥胖。在12个月内，使用二甲双胍与体重和WC增加的发生率显著降低相关。药剂师对于向临床医生和患者宣传二甲双胍对减少CIWG的益处至关重要。
