Should obesity be a limiting factor for clozapine treatment?
OBJECTIVE
Clozapine is the first choice in drug-resistant schizophrenia but also causes important weight changes. This might discourage clinicians concerned about the risk of developing health problems. To assess this issue we measured change in body mass index (cBMI) induced by clozapine at 18 and 56 weeks.


METHODS
Baseline body weight and height were measured and weight weekly thereafter during the first 18 weeks of treatment. After that, measurements were made monthly. Steady clozapine dose, clozapine and norclozapine blood concentrations, concomitant medication, gender and age were recorded.


RESULTS
At 18 weeks (n=76) mean cBMI was 1.83 kg/m(2). Baseline BMI was inversely correlated with cBMI. At 56 weeks (n=57) cBMI was 2.67 kg/m(2) and was inversely correlated with basal BMI. Multiple regression analysis replicated the results. When split with BMI categories, obese patients had lesser risk for further weight gain.


CONCLUSIONS
Obesity should not discourage clinicians from starting clozapine in drug-resistant patients.
Programa Esquizofrènia Clínic, Servei de Psiquiatria, Institut de Neurociències, Hospital Clínic de Barcelona. Barcelona, España.
Alexandre
A
Pons i Villanueva
Anna
A
Romero
Javier
J
Goti
Emilio
E
Fernandez-Egea
Juan
J
Undurraga
Xavier
X
Carne
Miquel
M
Bernardo
D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015992:Body Mass Index; D003024:Clozapine / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications*; D012044:Regression Analysis; D012189:Retrospective Studies; D012559:Schizophrenia / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome; D015430:Weight Gain / Q000187:drug effects*
D014150:Antipsychotic Agents; D003024:Clozapine