title: Iron homeostasis during risperidone treatment in children and adolescents.
abstract: OBJECTIVE
  Previous cross-sectional evidence has linked antipsychotic-related weight gain to reduced body iron concentration. Using longitudinal data, we examined the association between changes in weight following risperidone initiation or discontinuation and ferritin concentration.
  
  
  METHODS
  Study 1: Between April 2004 and September 2007, participants were enrolled from outpatient settings in a prospective randomized clinical trial comparing the efficacy of risperidone monotherapy to the combination of risperidone and behavior therapy in targeting disruptive behavior in 4- to 13-year-old children with DSM-IV-TR-based autism spectrum disorder. Study 2: Medically healthy 7- to 17-year-old participants in long-term open-label risperidone treatment at study entry returned for follow-up 1.5 years later, between July 2007 and July 2011. Available blood samples were used to measure ferritin. Linear multivariable regression analysis tested the association between ferritin concentration and change in age-sex-specific body mass index (BMI) z score between study entry and endpoint, adjusting for relevant confounders.
  
  
  RESULTS
  Study 1 sample consisted of 73 participants (85% males, mean age: 7.7 ± 2.4 years). After 18.0 ± 2.0 weeks on risperidone, their BMI z score increased by 0.93 ± 0.70 points and ferritin concentration declined by 6.8 ± 13.3 μg/L. After adjusting for age and sex, change in BMI z score was inversely correlated with percent change in ferritin concentration (β = -18.3, P < .003). Study 2 participants had all been receiving risperidone at study entry. At follow-up, 1.5 ± 0.3 years later, risperidone was discontinued in 26 of the 96 who were included in the analysis. Neither change in BMI z score nor in ferritin concentration was different between those who continued versus discontinued risperidone. However, a reduction in BMI z score between study entry and follow-up was associated with higher ferritin concentration at follow-up in participants who discontinued risperidone compared to those who continued it (P = .01).
  
  
  CONCLUSIONS
  Risperidone-related weight gain is associated with a reduction in body iron reserves, which appears to improve with weight loss following risperidone discontinuation. Preliminary evidence suggests that risperidone may also directly inhibit iron absorption.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier: NCT00080145.
authors: Baylor College of Medicine, Texas Children's Hospital, 1102 Bates Ave, Suite 790, Houston, TX 77030 chadi.calarge@bcm.edu.
authors: Chadi A
authors: CA
authors: Calarge
authors: Ekhard E
authors: EE
authors: Ziegler
authors: Nicole
authors: N
authors: Del Castillo
authors: Michael
authors: M
authors: Aman
authors: Christopher J
authors: CJ
authors: McDougle
authors: Lawrence
authors: L
authors: Scahill
authors: James T
authors: JT
authors: McCracken
authors: L Eugene
authors: LE
authors: Arnold
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000188:drug therapy* / Q000209:etiology; D000067877:Autism Spectrum Disorder / Q000150:complications / Q000188:drug therapy*; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D005293:Ferritins / Q000097:blood; D005500:Follow-Up Studies; D006706:Homeostasis; D006801:Humans; D007501:Iron / Q000378:metabolism*; D019189:Iron Metabolism Disorders / Q000139:chemically induced; D008297:Male; D016032:Randomized Controlled Trials as Topic; D018967:Risperidone / Q000008:administration & dosage / Q000009:adverse effects*; D015430:Weight Gain / Q000187:drug effects*
chemical_list: D014150:Antipsychotic Agents; D005293:Ferritins; D007501:Iron; D018967:Risperidone