Weight Gain and Metabolic Changes in Children and Adolescents Treated With Atypical Antipsychotics

December 7, 2009
Drug Benefit Trends, Drug Benefit Trends Vol 21 No 11, Volume 21, Issue 11

The results of a recent study showed that children and adolescents with serious mental illness treated with second-generation antipsychotic medications are likely to experience rapid weight gain.

The results of a recent study showed that children and adolescents with serious mental illness treated with second-generation antipsychotic medications are likely to experience rapid weight gain.1 The majority of these treatments are also associated with metabolic changes, said lead study author, Christoph Correll, MD, medical director of the Recognition and Prevention Program at the Zucker Hillside Hospital, Glen Oaks, NY. “The weight gain we observed was much more rapid and dramatic than previously described,” he said in an interview with Drug Benefit Trends.

The study included patients with serious mental illness, aged 4 to 19 years, who had been treated for 1 week or less with second-generation antipsychotic medications. Of the 205 who completed the study, 47.8% had mood spectrum disorders, 30.1% had schizophrenia disorders, and 22.1% had disruptive or aggressive behavior spectrum disorders. After about 11 weeks of treatment, average weight increases in each treatment group were as follows: olanzapine, 8.5 kg; quetiapine, 6.1 kg; risperidone, 5.3 kg; aripiprazole, 4.4 kg. The average weight increase in those untreated was 0.2 kg (Figure).

Correll found it surprising that each medication seemed to have its own “cardiometabolic signature.” Treatment with olanzapine caused the largest change in body composition weight gain as well as the greatest changes in metabolic parameters. Quetiapine was associated with adverse effects on all lipid parameters, while risperidone only caused a significantly adverse effect on triglyceride levels. Aripriprazole was associated with weight gain but no significant metabolic changes. “

These results mean that some medications attenuate the signal of weight on lipids and glucose metabolism and others can accentuate it,” he said. The results of this study reinforce the need for increased monitoring of patients treated with these therapies. Correll suggests that current American Diabetes Association guidelines for monitoring metabolic changes in patients treated with these medication should be revised for pediatric patients. “Currently, their guidelines are based on results of studies in adults and recommend screening at baseline, 3 months, and then annually. We propose that in pediatric patients this should occur at baseline, 3 months, and then every 6 months.”

References:

Reference
1. Correll CU, Manu P, Olshanskiy V, et al. Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents. JAMA.2009;302:1765-1773.

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