Treatment of clozapine‐associated obesity and diabetes with exenatide in adults with schizophrenia: A randomized controlled trial ( CODEX )
Abstract
Clozapine causes obesity and type 2 diabetes (T2DM). Glucagon‐like peptide‐1 (GLP‐1) receptor agonists (e.g. exenatide) can counter clozapine‐associated GLP‐1 dysregulation in animals, and may be beneficial in people on clozapine. This randomized, controlled, open‐label, pilot trial evaluated weekly exenatide for weight loss among clozapine‐treated obese adults with schizophrenia, with or without T2DM. A total of 28 outpatients were randomized to once‐weekly extended‐release subcutaneous exenatide or usual care for 24 weeks. The primary outcome was proportion of participants with >5% weight loss. All 28 participants completed the study; 3/14 in the exenatide group and 2/14 in the usual care group had T2DM. Six people on exenatide achieved >5% weight loss vs one receiving usual care ( P = .029). Compared with usual care, participants on exenatide had greater mean weight loss (−5.29 vs −1.12 kg; P = .015) and body mass index reduction (−1.78 vs −0.39 kg/m 2 ; P = .019), and reduced fasting glucose (−0.34 vs 0.39 mmol/L; P = .036) and glycated haemoglobin levels (−0.21% vs 0.03%; P = .004). There were no significant differences in other metabolic syndrome components. Exenatide may be a promising therapeutic agent for glycaemic control and weight loss in clozapine‐treated people with obesity, and could assist in reducing clozapine‐associated cardio‐metabolic morbidity and mortality.
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Preliminary evidence supports the efficacy of GLP-1 receptor agonists in antipsychotic-associated weight gain.
“with preliminary evidence supporting efficacy in AAWG.”
From Semaglutide for the treatment of antipsychotic-associated weight gain in patients not responding to metformin – a case series (2023) · cites this paper as [53]
Even modest improvements in fitness are associated with a 15% decrease in mortality in the general population.
“This can also produce important health benefits, as even modest improvements in fitness are associated with a 15% decrease in mortality in the general population.281”
From The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness (2019) · cites this paper as [281]
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- Authors
- Siskind, D. J., Russell, A. W., Gamble, C., Winckel, K., Mayfield, K., Hollingworth, S., Hickman, I., Siskind, V., & Kisely, S.
- Affiliations
- The University of Queensland (AU)
- Queensland Centre for Mental Health Research (AU)
- Logan Hospital (AU)
- School of Pharmacy University of Queensland Brisbane Australia
- Princess Alexandra Hospital (AU)
- Queensland University of Technology (AU)
- Corresponding author
- Siskind, Dan J
- Venue
- Diabetes, Obesity and Metabolism
- Publisher
- Wiley
- Published
- 2017-12-19
- Volume
- 20
- Issue
- 4
- Pages
- 1050-1055
- ISSN
- 1462-8902 (ISSN-L)
- 1463-1326
- OpenAlex
- W2772389138
- Cited by
- 98
- References
- 16
- Citations by year
- 2026: 19 · 2025: 16 · 2024: 14 · 2023: 14 · 2022: 10 · 2021: 8 · 2020: 5 · 2019: 5 · 2018: 6 · 2016: 1
- FWCI
- 3.60
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Obesity and Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Griffith Research Online (submittedVersion)
- Funders
- Rebecca L. Cooper Medical Research Foundation
- National Health and Medical Research Council (ECF APP1111136)
- PA Research Foundation
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- clozapine, exenatide, schizophrenia, obesity, type 2 diabetes, GLP-1 receptor agonists, weight loss, HbA1c, fasting blood glucose, metabolic syndrome
- MeSH terms
- Exenatide, Adolescent, Adult, Blood Glucose, Clozapine, Diabetes Mellitus, Type 2, Drug Administration Schedule, Female, Humans, Male, Middle Aged, Obesity, Pilot Projects, Schizophrenia, Weight Loss, Young Adult
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