This systematic review and meta-analysis included 32 randomized, open and double-blind, placebo-controlled studies (mean duration: 13.1 weeks, range: 6-16 weeks) with a total of 1482 subjects and which tested the following 15 medications: amantadine, dextroamphatamine, d-fenfluramine, famotidine, fluoxetine, fluvoxamine, metformin, nizatidine, orlistat, phenylpropanolamine, reboxetine, rosiglitazone, sibutramine, topiramate, and metformin plus sibutramine).
Five of the agents assessed lead to significantly greater weight loss than placebo. The greatest weight loss was achieved with metformin (N = 7, n = 334, -2.94 kg [CI, -4.89, -0.99]), followed by d-fenfluramine (N = 1, n = 16, -2.60 kg [CI,-5.14, -0.06]), sibutramine (N = 2, n = 55, -2.56 kg [CI, -3.91, -1.22]), topiramate (N = 2, n = 133, -2.52, [CI, -4.87, -0.16]) and reboxetine (N = 2, n = 79, -1.90 kg [CI, -3.07, -0.72]). Nausea rates did not differ between treatment and placebo groups. Results on the secondary outcome measures of waist circumference and weight gain, carbohydrate metabolism and blood lipids as well as sensitivity analysis regarding prevention vs intervention trials were largely heterogeneous. No significant differences between treatment and placebo groups were found for the secondary outcome measures of psychiatric symptoms and adverse events.
The Year in Psychosis and Bipolar Disorder: Treating Antipsychotic-related Metabolic Abnormalities
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