The metabolic adverse effects of antipsychotic use in individuals with intellectual and/or developmental disability: A systematic review and meta‐analysis

Abstract

Individuals with intellectual and/or developmental disability (IDD) are often prescribed antipsychotics (APs). However, despite their known propensity to cause metabolic adverse effects, including weight gain, diabetes, and increased risk of cardiovascular events, there is currently a limited body of literature describing the metabolic consequences of AP use in this population. Methods: We searched MEDLINE, EMBASE, PsychINFO, CENTRAL, and CINAHL databases to identify all randomized trials that reported on the metabolic effects of APs in individuals with IDD. Random effects meta-analyses were used to examine weight gain as both a continuous and dichotomous outcome.Results: Eighteen randomized trials met our inclusion criteria with a total of 1376 patients across a variety of IDDs. AP use was associated with significantly greater weight gain compared with placebo (Continuous: mean difference = 1.10 kg, [0.79, 1.40], p < 0.00001, I 2 = 54%; Dichotomous: odds ratio = 3.94, [2.15, 7.23], p < 0.00001, I 2 = 0). Sub-group analysis revealed no significant effect of AP type. Data regarding the effects of APs on other metabolic outcomes were limited. Conclusion: This review (PROSPERO # CRD42021255558) demonstrates that AP use is associated with significant weight gain among patients with IDD. Concerningly, most reported studies were in children and adolescents, which sets up an already vulnerable population for adverse medical sequalae at an early age. There was also a lack of long-term studies in adults with IDD. Further studies are required to better understand how AP use affects metabolic parameters in this group of individuals.Emily Smith and Nicolette Stogios shared first authorship.

Glucose and Lipid Profiles Predict Anthropometric Changes in Drug-Naïve Adolescents Starting Treatment with Risperidone or Sertraline: A Pilot Study

“…The increase in the number of prescriptions and the frequent off-label use imply careful assessment of the risk/benefit ratio before prescription of SSRIs and SGAs, as well as regular monitoring of adverse effects to optimize patient care. Indeed, use of these drugs for children and adolescents not only sets up an already vulnerable population for side effects at an early age but also represents a significant gap in the literature, especially due to the scarcity of safety-and tolerability-controlled clinical studies with respect to adulthood [3,4].…”