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CNS Drugs:抗精神病药增加儿童和青少年体重 “神药”二甲双胍能减重吗?

2018-10-23 吴星 环球医学

体重增加是第二代抗精神病药(SGAs)的一个潜在顾虑的不良反应。二甲双胍,一种具有降糖作用的双胍类药物,被用于管理使用SGAs进行治疗的成人的体重。2018年9月,发表在《CNS Drugs》的一项系统评价和荟萃分析调查了二甲双胍对SGAs治疗儿童和青少年体重增加的影响。

体重增加是第二代抗精神病药(SGAs)的一个潜在顾虑的不良反应。二甲双胍,一种具有降糖作用的双胍类药物,被用于管理使用SGAs进行治疗的成人的体重。2018年9月,发表在《CNS Drugs》的一项系统评价和荟萃分析调查了二甲双胍对SGAs治疗儿童和青少年体重增加的影响。

目的:本研究的目的是开展对随机对照试验(RCTs)的首个系统评价和荟萃分析,评价二甲双胍对SGAs治疗儿童和青少年体重增加的影响。

方法:基于既往注册的方案(PROSPERO-CRD42017074839),研究者检索了PubMed、EMBASE、PsychoINFO、BIOSIS、Science Direct、Cochrane Central和ClinicalTrials.gov电子数据库中截至2018年3月,评价二甲双胍或安慰剂对任何精神疾病的SGAs(利培酮、阿立哌唑、奥氮平,及氯氮平)儿童或青少年使用者(<18岁)体重影响的RCTs(对语言、日期或出版类型没有限制)。研究者还联系了相关药物制造商,获取可能更多的相关研究或数据。使用随机效应模型,并使用Cochrane风险偏倚评价工具,对纳入RCTs的质量进行评价。

结果:这项荟萃分析纳入5项RCTs(共205例受试者)。研究者发现治疗4、12和16周后,与安慰剂相比,二甲双胍组的体重有显著降低{平均差异,-0.98 kg (95%置信区间[CI] -1.26~-0.69);分别为-1.83 kg(95% CI - 2.47~- 1.18);-3.23 kg(95% CI - 5.59~- 0.86)}。第2周和第8周的体重降低不具有统计显著性。体质指数(BMI)的降低与体重平行,在第4、12和16周具有统计显著性。总之,4项研究被评定为偏倚风险不清楚,1项研究被评定为偏倚风险较高。

结论:荟萃分析的证据显示,二甲双胍或能降低SGAs治疗儿童/青少年使用者的体重,但需要更多的高质量证据。临床医师需要认识到二甲双胍的使用目前是超说明书用药的状态。

原始出处:

Ellul P, Delorme R, Cortese S. Metformin for Weight Gain Associated with Second-Generation Antipsychotics in Children and Adolescents: A Systematic Review and Meta-Analysis. CNS Drugs. 2018 Sep 20. doi: 10.1007/s40263-018-0571-z. [Epub ahead of print]

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    2018-12-04 wangbingxhy
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    2019-10-06 lg.zhao
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    2019-09-16 tsing_hit
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    2018-11-03 1e145228m78(暂无匿称)

    学习了,谢谢作者分享!

    0

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  8. [GetPortalCommentsPageByObjectIdResponse(id=1862318, encodeId=5b56186231847, content=<a href='/topic/show?id=1f0e626267' target=_blank style='color:#2F92EE;'>#Drug#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6262, encryptionId=1f0e626267, topicName=Drug)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=baf586, createdName=wangbingxhy, createdTime=Tue Dec 04 19:40:00 CST 2018, time=2018-12-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1797870, encodeId=6c581e9787072, content=<a href='/topic/show?id=27262399169' target=_blank style='color:#2F92EE;'>#二甲双胍能#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23991, encryptionId=27262399169, topicName=二甲双胍能)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=263b421, createdName=zhaozuguo, createdTime=Thu Apr 25 04:40:00 CST 2019, time=2019-04-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1914255, encodeId=3e861914255ac, content=<a href='/topic/show?id=4b8349356f' target=_blank style='color:#2F92EE;'>#CNS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4935, encryptionId=4b8349356f, topicName=CNS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c737344, createdName=lg.zhao, createdTime=Sun Oct 06 07:40:00 CST 2019, time=2019-10-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1937476, encodeId=f7a5193e47656, content=<a href='/topic/show?id=b3252822854' target=_blank style='color:#2F92EE;'>#儿童和青少年#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=28228, encryptionId=b3252822854, topicName=儿童和青少年)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aa0e14, createdName=lifestar, createdTime=Thu Dec 06 14:40:00 CST 2018, time=2018-12-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1784766, encodeId=e19c1e8476690, content=<a href='/topic/show?id=e451626993' target=_blank style='color:#2F92EE;'>#drugs#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6269, encryptionId=e451626993, topicName=drugs)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dcaa509, createdName=tsing_hit, createdTime=Mon Sep 16 17:40:00 CST 2019, time=2019-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=351347, encodeId=995835134e34, content=学习了,谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Sat Nov 03 07:31:26 CST 2018, time=2018-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1513091, encodeId=9b3915130910c, content=<a href='/topic/show?id=bdc555596cd' target=_blank style='color:#2F92EE;'>#抗精神病药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55596, encryptionId=bdc555596cd, topicName=抗精神病药)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=694d10531994, createdName=12498768m16(暂无昵称), createdTime=Thu Oct 25 08:40:00 CST 2018, time=2018-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=350303, encodeId=da193503039c, content=抗精神病药增加儿童体重。, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Tue Oct 23 20:57:57 CST 2018, time=2018-10-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=350297, encodeId=4bad35029e7b, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=82311653708, createdName=医者仁心5538, createdTime=Tue Oct 23 19:27:17 CST 2018, time=2018-10-23, status=1, ipAttribution=)]
    2018-10-23 jyzxjiangqin

    抗精神病药增加儿童体重。

    0

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    2018-10-23 医者仁心5538

    学习了

    0

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