title: A systematic review and meta-analysis of randomised controlled trials of treatments for clozapine-induced obesity and metabolic syndrome.
abstract: Metabolic complications are commonly found in people treated with clozapine. Reviews on the management of this problem have generally drawn conclusions by grouping different types of studies involving patients treated with various different antipsychotics. We carried out a systematic review and meta-analysis of pharmacological and non-pharmacological treatments for clozapine-induced obesity or metabolic syndrome. Two researchers independently searched PubMed and Embase for randomised controlled trials (RCTs) of treatments for clozapine-induced obesity or metabolic syndrome. All other types of studies were excluded. We only included RCTs where more than 50% of participants were taking clozapine. We identified 15 RCTs. Effective pharmacological treatments for clozapine-induced obesity and metabolic syndrome include metformin, aripiprazole, and Orlistat (in men only). Meta-analysis of three studies showed a robust effect of metformin in reducing body mass index and waist circumference but no effects on blood glucose, triglyceride levels, or HDL levels. In addition, there is limited evidence for combined calorie restriction and exercise as a non-pharmacological alternative for the treatment of clozapine-induced obesity, but only in an in-patient setting. Rosiglitazone, topiramate, sibutramine, phenylpropanolamine, modafinil, and atomoxetine have not shown to be beneficial, despite reports of efficacy in other populations treated with different antipsychotics. We conclude that randomised-controlled trial data support the use of metformin, aripiprazole, and Orlistat (in men only) for treating clozapine-induced obesity. Calorie restriction in combination with an exercise programme may be effective as a non-pharmacological alternative. Findings from trials in different populations should not be extrapolated to people being treated with clozapine.
authors: Department of Psychiatry, University of Cambridge, UK; Elizabeth House, Fulbourn Hospital, Fulbourn, Cambridge, CB21 5EF, UK. Electronic address: jz308@cam.ac.uk.
authors: Jorge
authors: J
authors: Zimbron
authors: Department of Psychiatry, University of Cambridge, UK; Elizabeth House, Fulbourn Hospital, Fulbourn, Cambridge, CB21 5EF, UK.
authors: Golam M
authors: GM
authors: Khandaker
authors: Department of Neuropsychiatry, University College London, Gower Street, London, WC1E 6BT, UK.
authors: Chiara
authors: C
authors: Toschi
authors: Department of Psychiatry, University of Cambridge, UK.
authors: Peter B
authors: PB
authors: Jones
authors: Department of Psychiatry, University of Cambridge, UK; Elizabeth House, Fulbourn Hospital, Fulbourn, Cambridge, CB21 5EF, UK; Behavioural and Clinical Neuroscience Institute (BCNI), University of Cambridge, UK.
authors: Emilio
authors: E
authors: Fernandez-Egea
mesh_terms: D019440:Anti-Obesity Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003024:Clozapine / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D024821:Metabolic Syndrome / Q000139:chemically induced* / Q000628:therapy*; D009765:Obesity / Q000139:chemically induced* / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic
chemical_list: D019440:Anti-Obesity Agents; D014150:Antipsychotic Agents; D003024:Clozapine
keywords: Clozapine; Meta-analysis; Metabolic syndrome; Schizophrenia; Treatment