Şizofreni Hastalarında Kilo Kaybı için Metformin Kullanımı…

American Journal of Psychiatry Temmuz sayısında yayınlanan yeni çalışmada, Metformin kullanımı ile elde edilen dikkat çekici yararlı sonucu ve çalışma özet linkini ilginize sunuyoruz– TürkPsikiyatri |

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Metformin for Weight Loss and Metabolic Control in Overweight Outpatients With Schizophrenia and Schizoaffective Disorder

Jarskog LF, Hamer RM, Catellier DJ, et al, for the METS Investigators

Am J Psychiatry. 2013 Jul 12. [Epub ahead of print]

Study Summary

In this double-blind study, 148 clinically stable, overweight (body mass index [BMI] at least 27 kg/m2) adult outpatients (aged 18-65 years) with chronic schizophrenia or schizoaffective disorder were randomly assigned to receive 16 weeks of metformin (titrated up to 1000 mg twice daily) or placebo. Participants had a duration of illness of at least 1 year and were receiving 1 or a combination of 2 US Food and Drug Administration-approved antipsychotics, with no change in antipsychotic agents for 2 months and no change in dosage for 1 month before study entry. Concomitant medications were allowed if dosages were unchanged for 1 month before study entry. All patients received weekly diet and exercise counseling.

Fifty-eight (77.3%) patients who received metformin and 58 (81.7%) who received placebo completed a 16-week treatment course. The mean change in body weight was -3.0 kg (95% confidence interval [CI], -4.0 to -2.0) in the metformin group and -1.0 kg (95% CI, -2.0 to 0.0) in the placebo group. There was also a significant between-group advantage for BMI (-0.7; 95% CI, -1.1 to -0.2), triglyceride level (-20.2 mg/dL; 95% CI -39.2 to -1.3) and hemoglobin A1c level (-0.07%; 95% CI -0.14 to -0.004) with metformin. Metformin-associated side effects were primarily gastrointestinal and transient, and they rarely led to treatment discontinuation. Per the study authors, “A significant time-by-treatment interaction suggests that the benefits of metformin may continue to accrue with longer treatment.”

Viewpoint

The effects of metformin on weight and metabolic variables have been researched in people with diabetes and prediabetes. Metformin can cause appetite suppression and slowing of gastric emptying. Metformin has been used to study weight loss or to prevent antipsychotic-induced weight gain in nondiabetic patients with schizophrenia with varying results and may be most useful in children and adults with first-episode schizophrenia. Remarkably, the study by Jarskog and colleagues demonstrated weight loss (albeit modest) in a typical sample of overweight adults with a chronic psychotic illness.

Over 16 weeks, the group receiving metformin (mean final dose, 1887 mg/day) experienced a 2.8% weight reduction vs a 1.0% reduction in the placebo group. Thirteen (17.3%) in the metformin group lost more than 5% of their baseline weight vs 7 (9.8%) who received placebo, for a number needed to treat of 14 (not statistically significant); however, the authors noted that weight loss may continue beyond 16 weeks. Diarrhea was reported significantly more frequently with metformin (33.3%) than with placebo (16.9%), for a number needed to harm (NNH) of 7 (95% CI, 4-38). Only a few patients discontinued the trial because of any adverse event; 11 (14.7%) of patients in the metformin group vs 8 (11.3%) in the placebo group discontinued the study because of intolerability, for an NNH of 30 (not statistically significant). The bottom line is that metformin may be worth trying, but warn patients about potential transient diarrhea.

Abstract

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