Weight gain and comorbidities associated with oral second-generation antipsychotics: analysis of real-world data for patients with schizophrenia or bipolar I disorder

Abstract

Background Many second-generation antipsychotics (SGAs) are associated with weight gain and cardiometabolic effects. Antipsychotic-associated weight gain is linked to treatment interruptions, potentially increasing risk of relapse and hospitalization. This retrospective study assessed clinically significant weight gain (CSWG), treatment interruptions, and development of cardiometabolic conditions in patients with schizophrenia (SZ) or bipolar I disorder (BD-I) following initiation of oral SGAs with moderate to high weight gain risk. Methods Patients with no prior use of moderate to high weight gain risk oral SGAs were identified from patient-level medical/pharmacy claims and electronic medical records (January 2013–February 2020; OM1 Real-World Data Cloud). Those with ≥ 1 weight measurement in both the 12 months preceding and 3 months after SGA initiation (index date) were analyzed for continuous changes in weight, CSWG (≥ 7% and ≥ 10% increases from baseline), treatment interruptions (switches/discontinuations), and development of cardiometabolic conditions. Results Median follow-up times in the SZ (n = 8174) and BD-I (n = 9142) cohorts were 153.4 and 159.4 weeks, respectively; 45.5% and 50.7% were obese at baseline. Mean (SD) percent weight increase during treatment was 3.3% (7.2) and 3.7% (7.0) for patients with SZ and BD-I, respectively, and was highest for underweight/normal weight patients (SZ: 4.8% [8.1]; BD-I: 5.5% [8.7]). More than 96% had treatment interruptions during follow-up, primarily discontinuations. CSWG and treatment interruptions occurred within a median of 13 and 14 weeks after treatment initiation, respectively. Of patients with CSWG and treatment interruptions, approximately 75% did not return to baseline weight during follow-up. Among those without baseline cardiometabolic conditions, 14.7% and 11.3% of patients with SZ or BD-I, respectively, developed ≥ 1 condition over 12 months post-index. Incidence was generally highest among those who were overweight/obese at baseline and those who experienced CSWG. Conclusions In this analysis of real-world data, both weight gain and treatment interruptions occurred early in treatment for patients with SZ or BD-I. Treatment-associated weight gain persisted despite switching or discontinuing index treatment. Additionally, cardiometabolic morbidity increased within 12 months of treatment initiation. Patients with SZ or BD-I are at greater risk than the general population for cardiometabolic conditions; weight gain associated with SGAs may exacerbate these health risks.

Bipolar disorder: The foundational role of mood stabilizers

“…19,20 Similarly, the increased use of antipsychotics is driven by evidence that antipsychotics are effective for treating bipolar depression and preventing the recurrence of manic and (for some antipsychotics) depressive episodes. 21,22 However, long-term antipsychotic use causes brain volume change in patients with schizophrenia 23 or major depressive disorder 24 and in nonhuman primates 25,26 ; metabolic Bipolar disorder: The foundational role of mood stabilizers Clinical Neuroscience abnormalities [27][28][29][30][31] ; and cardiovascular adverse effects. 32 Antipsychotics are believed to be associated with withdrawal psychosis.…”

“…33 Antipsychotics are appealing because they appear to be equally effective and generally well tolerated. But these agents cause problems that are difficult to see in routine visits, such as metabolic [27][28][29][30][31] and cardiovascular adverse effects 29 as well as reductions in brain volume. [23][24][25][26] Mechanistic research suggests that mood stabilizers directly correct known pathophysiologic anomalies with additional protective effects, whereas antipsychotics appear to create new abnormalities and contribute to medical problems.…”

The role of pharmacists in supporting service users to optimise antipsychotic medication

“…There is a paucity of research focussing on service users’ perspectives [ 23 ]. Qualitative research has found some service users appreciate reductions in symptoms, whereas others believe medication has harmed them [ 2 , 24 , 25 ]. Consequently, adherence is problematic, with rates varying widely [ 26 , 27 ].…”

Unmet needs with antipsychotic treatment in schizophrenia and bipolar I disorder: patient perspectives from qualitative focus groups

“…Despite their effectiveness, antipsychotic medications are associated with side effects, including weight gain and metabolic disturbances, sedation/somnolence, sexual dysfunction, amenorrhea and galactorrhoea, and neurologic symptoms (eg, parkinsonism or akathisia), that may add to the underlying disease burden [11,[18][19][20]. Many people find these side effects a hinderance to daily functioning [21,22], contributing to suboptimal medication adherence and/or treatment discontinuation, which are common across both conditions [21][22][23], increasing the risk of hospitalisation and associated direct medical costs [16,[24][25][26].…”