A Meta-Analysis of Dropout and Metabolic Effects of Antipsychotics in Anorexia Nervosa

Abstract

Background: Second-generation antipsychotics are often used off-label in the treatment of anorexia nervosa (AN) across the clinical spectrum. Patients with anorexia nervosa often cite concerns about metabolic effects, such as weight gain, as reasons for their reluctance to start or continue second-generation antipsychotics. Improving our understanding of the metabolic effect patients experience and reasons underlying their disinclination will enable us to build rapport and guide our clinical decisions. We therefore aimed to conduct a comprehensive review of dropouts, metabolic effects, and patient-reported outcomes associated with second-generation antipsychotic in people with AN. Method: EMBASE, Medline, and PsycINFO were searched for all relevant studies published until 2019, and retrieved studies were assessed for eligibility as per predefined inclusion criteria. A random-effects meta-analysis was conducted to assess overall dropout rates. Results: Of 983 citations retrieved, 21 studies met the inclusion criteria for the systematic review and 10 studies had appropriate data for meta-analysis. Using the random effects model, the pooled dropout rate in the intervention arm (95% confidence interval) from psychopharmacological trials was 28% (19 to 38%) in people with AN. Personal reasons or factors associated with study were commonest reason for dropout, not adverse events or metabolic effects as hypothesized. Conclusion: Compared to personal reasons, drug-related factors such as side effects seem to play a lesser role for the discontinuation of antipsychotic treatment under trial conditions. This suggests an urgent need to consider and fully examine potential individual and patient-related factors that influence dropout rates in psychopharmacological trials and treatment compliance in clinical settings.

Efficacy and tolerance of second-generation antipsychotics in anorexia nervosa: A systematic scoping review

“…The tolerability of these four medications was globally good in this population at risk. The side effects are mostly mild and transient [74]. These prescriptions nonetheless necessitate close cardiac, laboratory, and neurological monitoring [76,77].…”

“…Kan et al [74] published a meta-analysis assessing the dropout rate and metabolic effects associated with antipsychotic prescriptions in AN. The authors remarked that patient-associated factors explain dropout rates in the trials more than drug-related side effects do.…”

“…Kan et al [74] also examined, as did Swenne et al [75], diverse side effects associated with the prescription of olanzapine. Kan's team [74] reported that sedation is the most frequently reported adverse effect, followed by vertigo, headaches, gastrointestinal problems, insomnia, fatigue, and muscle pain. Some studies mention dry mouth, concentration issues, vision…”

The Therapeutic Process – Client's Perception Of Success Promoting Factors In An And Arfid – Qualitative Study

“…The lack of clear information identifying and understanding the underlying pathophysiological mechanisms that enhance the emergence and maintenance of different EDs delays the selection/development of effective intervention models adjusted to the needs of these populations (Kan et al, 2020;Treasure et al, 2020;Watson et al, 2019).…”

“…Scienti c research reveals the negative impact and harshness of the suffering caused by living with AN or ARFID. Thus, high levels of dropout of the therapeutic process (20% to 50%) (Kan et al, 2020;Linardon et al, 2018;O'Keeffe et al, 2018;Swift & Greenberg, 2012;Vinchenzo et al, 2021) could promote the recovery and improvement of this patient's live quality (Giel et al, 2021;Hauber et al, 2020;Swift & Greenberg, 2012).…”