OBJECTIVES:Second-generation antipsychotics (SGAs) increase appetite and weight, leading toward a metabolic syndrome. Risperidone and aripiprazole, the most widely used pediatric SGAs, have been studied predominantly in short-term clinical trials, where risperidone leads to a rapid weight increase and aripiprazole to a slower one, while long-term effects are not yet elucidated. Factors that may influence weight gain are likewise not clarified, although baseline weight, previous SGA exposure, pubertal status, and type of SGA have been suggested as moderators. We analyzed weight gain induced by risperidone and aripiprazole in a sample of pediatric outpatients enrolled into a 2-year observational study. METHODS:We assessed at several time points their body mass index (BMI)-Z scores (age and sex-corrected and referred to national norms). We used hierarchical mixed-effects modeling to design BMI-Z trajectories and observed the effects of several variables on determining them. RESULTS:The study group comprised of 127 patients, predominantly males (79%), of 12.6 years on average, treated with risperidone (81%) and aripiprazole (19%) for disruptive behavioral symptoms in patients with and without neurodevelopmental disorders. Overall, BMI-Z was 1.2 at first and 1.4 at last visit (no significant change). We could design four weight-change trajectories, determined by the factors: drug (risperidone/aripiprazole) and age status (children/adolescent). Additional factors not retained in the model but possibly explanatory include the previous duration of SGA treatment and a progressive patient-selection effect due to dropouts in this observational study. Risperidone treatment was associated with trends of BMI-Z increase in children and decrease in adolescents. Aripiprazole treatment was associated with significant BMI-Z increase, higher in children than in adolescents. Results are probably due to longer previous drug exposure in adolescents. CONCLUSIONS:Children were at risk of weight gain more than adolescents, for both risperidone and, of note, aripiprazole. Adolescents and patients with long previous drug exposure tend to reach stable BMI-Z, although in the range between excessive weight and obesity.

译文

目的:第二代抗精神病药(SGA)会增加食欲和体重,从而导致新陈代谢综合症。利培酮和阿立哌唑是最广泛使用的儿科SGA,主要是在短期临床试验中进行研究,其中利培酮导致体重迅速增加,阿立哌唑的体重增加较慢,而长期作用尚不清楚。尽管基线体重,先前的SGA暴露,青春期状态和SGA类型已被建议作为缓和剂,但仍未阐明可能影响体重增加的因素。我们分析了利培酮和阿立哌唑在一项为期2年的观察性研究中的儿科门诊样本中引起的体重增加。
方法:我们在几个时间点评估他们的体重指数(BMI)-Z得分(年龄和性别校正并参考国家规范)。我们使用分层混合效应建模来设计BMI-Z轨迹,并观察了几个变量对确定它们的影响。
结果:该研究组由127名患者组成,平均为男性(79%),平均为12.6岁,接受利培酮(81%)和阿立哌唑(19%)治疗具有和不具有神经发育障碍的患者的破坏性行为症状。总体而言,BMI-Z初次访问时为1.2,最后一次访问时为1.4(无明显变化)。我们可以设计四个由体重决定的体重变化轨迹:药物(利培酮/阿立哌唑)和年龄状态(儿童/青少年)。该模型中未保留的其他因素,但可能是解释性的,包括先前的SGA治疗持续时间以及由于该观察性研究中的辍学而导致的逐步患者选择效应。利培酮治疗与儿童BMI-Z升高和青少年BMI-Z升高趋势相关。阿立哌唑治疗与BMI-Z显着增加有关,儿童中的BMI-Z高于青少年。结果可能是由于青少年以前接触药物的时间更长。
结论:利培酮和阿立哌唑的患儿体重增加的风险均比青少年高。青少年和长期吸毒的患者倾向于达到稳定的BMI-Z,尽管介于体重过多和肥胖之间。

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