Sustained Weight Loss After Treatment With a Glucagon-Like Peptide-1 Receptor Agonist in an Obese Patient With Schizophrenia and Type 2 Diabetes

Ishøy, Pelle L.; Knop, Filip K.; Vilsbøll, Tina; Glenthøj, Birte; Ebdrup, Bjørn H

doi:10.1176/appi.ajp.2013.12101344

Cited by 21 publications

(20 citation statements)

References 3 publications

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“…Interestingly, GLP-1 receptor agonists also induce weight loss in both diabetic and nondiabetic patients, 48 and they may therefore be used to treat antipsychotic-induced obesity. [49][50][51] Endogenous GLP-1 levels have been reported in 2 studies 39,41 evaluating the effect of short-term olanzapine treatment in healthy subjects: Vidarsdottir et al 39 showed no effect of olanzapine, whereas Teff et al 41 recently reported increases in postprandial GLP-1 levels. To our knowledge, the present study is the first to report plasma levels of endogenous GLP-1 in patients treated with antipsychotic drugs.…”

Section: Discussionmentioning

confidence: 99%

Glucometabolic Hormones and Cardiovascular Risk Markers in Antipsychotic-Treated Patients

Ebdrup¹,

Knop²,

Madsen³

et al. 2014

J. Clin. Psychiatry

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Objective: Treatment with antipsychotic drugs is widely associated with metabolic side effects such as weight gain and disturbed glucose metabolism, but the pathophysiologic mechanisms are unclear.Method: Fifty nondiabetic (fasting plasma glucose ≤ 7.0 mmol/L), antipsychotic-treated male patients (ICD-10 diagnosis code F20, F21, F22, F25, F28, or F60; mean ± SD age = 33.0 ± 6.7 years; body mass index [BMI; kg/ m 2 ] = 26.0 ± 4.7; waist circumference = 95.9 ± 13.3 cm; glycated hemoglobin A 1c [HbA 1c ] = 5.7% ± 0.3%) and 93 age-and waist circumference-matched healthy male controls (age = 33 ± 7.3 years; BMI = 26.1 ± 3.9; waist circumference = 94.6 ± 11.9 cm; HbA 1c = 5.7% ± 0.3%) participated in this cross-sectional study. Blood was sampled in the fasting state and 90 minutes after ingestion of a standardized liquid meal (2,268 kJ). The primary outcomes were glucometabolic hormones and cardiovascular risk markers. Data were collected between March 2008 and February 2010.Results: Compared to healthy controls, patients were characterized by elevated fasting levels of proinsulin, C-peptide, and glucose-dependent insulinotropic polypeptide (GIP) (P < .05) and higher postprandial levels of insulin, proinsulin, C-peptide, and GIP (P ≤ .02). Also, patients exhibited elevated plasma levels of C-reactive protein and signs of dyslipidemia. Fasting plasma levels of insulin, glucagon, glucagon-like peptide-1 (GLP-1), ghrelin, leptin, adiponectin, tumor necrosis factor-α, plasminogen activator inhibitor-1, and interleukin-6 and postprandial levels of glucagon, GLP-1, ghrelin, leptin, and adiponectin did not differ between groups. Conclusions:Presenting with an insulin resistant-like pattern, including beta cell hypersecretion and elevated GIP levels, nondiabetic antipsychotic-treated patients display emerging signs of dysmetabolism and a compromised cardiovascular risk profile. The appetite-regulating hormones GLP-1 and ghrelin appear not to be influenced by antipsychotic treatment. Our findings provide new clinical insight into the pathophysiology associated with metabolic side effects of antipsychotic treatment and put emphasis on the importance of implementing metabolic screening into psychiatric practice.Trial Registration: ClinicalTrials.gov identifier NCT00627757 Clin Psychiatry 2014;75(9):e899-e905 J

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Section: Discussionmentioning

confidence: 99%

Glucometabolic Hormones and Cardiovascular Risk Markers in Antipsychotic-Treated Patients

Ebdrup¹,

Knop²,

Madsen³

et al. 2014

J. Clin. Psychiatry

Self Cite

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“…However, in laboratory animal studies, liraglutide has been shown to reverse olanzapine-induced weight gain (e.g. Lykkegaard et al, 2008) and in a case report appears to have assisted weight loss in an obese female patient with schizophrenia (Ishoy et al, 2013). A clinical trial of exenatide for olanzapine-induced weight gain is in progress in the USA.…”

Section: Treatments With Evidence In General Population Studies But Nmentioning

confidence: 99%

BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment

et al. 2016

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Excess deaths from cardiovascular disease are a major contributor to the significant reduction in life expectancy experienced by people with schizophrenia. Important risk factors in this are smoking, alcohol misuse, excessive weight gain and diabetes. Weight gain also reinforces service users' negative views of themselves and is a factor in poor adherence with treatment. Monitoring of relevant physical health risk factors is frequently inadequate, as is provision of interventions to modify these. These guidelines review issues surrounding monitoring of physical health risk factors and make recommendations about an appropriate approach. Overweight and obesity, partly driven by antipsychotic drug treatment, are important factors contributing to the development of diabetes and cardiovascular disease in people with schizophrenia. There have been clinical trials of many interventions for people experiencing weight gain when taking antipsychotic medications but there is a lack of clear consensus regarding which may be appropriate in usual clinical practice. These guidelines review these trials and make recommendations regarding appropriate interventions. Interventions for smoking and alcohol misuse are reviewed, but more briefly as these are similar to those recommended for the general population. The management of impaired fasting glycaemia and impaired glucose tolerance ('pre-diabetes'), diabetes and other cardiovascular risks, such as dyslipidaemia, are also reviewed with respect to other currently available guidelines.These guidelines were compiled following a consensus meeting of experts involved in various aspects of these problems. They reviewed key areas of evidence and their clinical implications. Wider issues relating to primary care/secondary care interfaces are discussed but cannot be resolved within guidelines such as these.

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“…In the only published report of liraglutide, an obese woman with schizophrenia receiving clozapine had a sustained weight loss of 8.7% over 2 years. Liraglutide was well tolerated and there were no adverse psychiatric effects [143].…”

Section: Pharmacotherapy For Psychotropic-associated Weight Gainmentioning

confidence: 91%

Managing comorbid obesity and depression through clinical pharmacotherapies

McElroy

Guerdjikova

Mori

et al. 2016

Expert Opinion on Pharmacotherapy

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When treating a patient with a mood disorder and obesity, both conditions need to be a focus of clinical attention. Psychotropic medications that have minimal weight gain effects should be used if possible. Weight-loss agents can probably be used in some mood disorder patients, but must be done so cautiously and with a full understanding of their potential psychiatric effects and interactions with psychotropic medications. Knowledge of the pharmacotherapy of binge eating and psychotropic-induced weight gain is also crucial.

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Sustained Weight Loss After Treatment With a Glucagon-Like Peptide-1 Receptor Agonist in an Obese Patient With Schizophrenia and Type 2 Diabetes

Cited by 21 publications

References 3 publications

Glucometabolic Hormones and Cardiovascular Risk Markers in Antipsychotic-Treated Patients

Glucometabolic Hormones and Cardiovascular Risk Markers in Antipsychotic-Treated Patients

BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment

Managing comorbid obesity and depression through clinical pharmacotherapies

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