Metformin for weight reduction in non-diabetic patients on antipsychotic drugs: a systematic review and meta-analysis
Abstract
Weight gain is a clinically important side effect of antipsychotic drug therapy. The aim of this study was to determine the effect of the antidiabetic drug metformin on antipsychotic-induced weight gain in non-diabetic patients. In a systematic literature review we identified 195 citations from which seven randomized, placebo-controlled studies (398 patients) were included in the final analysis. Studies in adults ( n = 5) and in children ( n = 2) were analysed separately. Compared with placebo, metformin treatment caused a significant body weight reduction in adult non-diabetic patients treated with atypical antipsychotics (4.8%, 95% CI 1.6 to 8.0) and in children (4.1%, 95% CI 2.2 to 6.0). There was evidence of substantial heterogeneity among studies, and when the analysis was restricted to patients with a manifest (>10%) body weight increase prior to randomisation metformin reduced weight by 7.5% (95% CI 2.9 to 12.0). The effect was larger in Asians (7.8%, 95% CI 4.4 to 11.2) than in Hispanics (2.0%, 95% CI 0.7 to 3.3). In conclusion, metformin has a pronounced weight-reducing effect in antipsychotic-treated patients, especially in those with a manifest weight gain. Although direct comparisons are lacking, the observed effect on body weight compares favourably with the effect of sibutramine and orlistat, approved for weight reduction. However, metformin is not approved for use in non-diabetic patients and it is still not generally advisable to recommend metformin to counteract antipsychotic-induced weight gain.
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Seven meta-analyses comprised studies with high (>90%) average power.
“However, seven meta-analyses comprised studies with high (>90%) average power 24,26,31,57,63,68,71 .”
From Power failure: why small sample size undermines the reliability of neuroscience (2013) · cites this paper as [26]
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Goran, M. I. (2016) · CRC Press eBooks · doi:10.1201/9781315370958-31
Qi, J., Dong, M., Gou, Q., & Zhu, H. (2024) · Cell Biochemistry and Biophysics · doi:10.1007/s12013-024-01269-x
- Authors
- Björkhem-Bergman, L., Asplund, A. B., & Lindh, J. D.
- Affiliations
- Division of Clinical Pharmacology, Karolinska University Hospital, Huddinge, Karolinska Institutet, 141 86, Stockholm, Sweden.
- Karolinska University Hospital (SE)
- Corresponding author
- Lindh, Jonatan D
- ORCID
- Lindh, Jonatan D
- Venue
- Journal of Psychopharmacology
- Publisher
- SAGE Publications
- Published
- 2010-01-15
- Volume
- 25
- Issue
- 3
- Pages
- 299-305
- ISSN
- 0269-8811 (ISSN-L)
- 1461-7285
- OpenAlex
- W2036358842
- Cited by
- 72
- References
- 28
- Citations by year
- 2025: 2 · 2024: 4 · 2023: 1 · 2022: 5 · 2021: 4 · 2020: 5 · 2019: 8 · 2018: 4 · 2017: 3 · 2016: 6 · 2015: 10 · 2014: 4 · 2013: 5 · 2012: 5
- FWCI
- 0.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychopharmacology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Karolinska Institutet
- Stockholms Läns Landsting
- Topics
- Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Keywords
- metformin, antipsychotic-induced weight gain, atypical antipsychotics, weight loss, non-diabetic patients, body weight, children, ethnic differences, sibutramine, orlistat
- MeSH terms
- Adult, Child, Humans, Hypoglycemic Agents, Metformin, Antipsychotic Agents, Weight Gain, Weight Loss, Racial Groups
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