Metformin effective for prevention of clozapine-induced weight gain: study

Clozapine is presently the sole antipsychotic with an indication for treatment-resistant Schizophrenia but is associated with significant weight gain and other metabolic aberrations. This retrospective chart review aimed to evaluate the effectiveness of adjunctive metformin in preventing clozapine-induced weight gain.

They conducted a retrospective chart review of patients newly initiated on clozapine at the Centre for Addiction and Mental Health in Canada, from November 2014 to April 2021. Our primary outcome was body weight at 6 and 12 months after clozapine initiation. Other metabolic parameters served as secondary outcomes.

Results

• Among 396 patients (males: 71.5%, mean age: 42.8 years) initiated on clozapine, 69 were on metformin or prescribed it ≤3 months after clozapine initiation.
• The clozapine+metformin group demonstrated less weight gain compared with the clozapine-only group at 6 months and 12 months after clozapine initiation
• Adaptive changes were also observed for fasting glucose and triglycerides in the clozapine+metformin group compared with clozapine only.

In this large retrospective naturalistic cohort study, co-prescription of clozapine and metformin was associated with less weight gain and related metabolic dysfunction at 6 and 12 months after initiation versus clozapine alone. These findings provide evidence for the effectiveness of metformin in preventing clozapine-induced weight gain; larger randomized controlled trials are needed to confirm these results.

Reference:

Stogios N, Maksyutynska K, Navagnanavel J, et al. Metformin for the prevention of clozapine-induced weight gain: A retrospective naturalistic cohort study. Acta Psychiatrica Scandinavica.

DOI: 10.1111/acps.13462.

Keywords:

Stogios N, Maksyutynska K, Navagnanavel J, Metformin, prevention, clozapine, induced, weight, gain, retrospective, naturalistic, cohort, study, Acta, Psychiatrica, Scandinavica, Nicolette Stogios,Kateryna Maksyutynska,Janani Navagnanavel,Marcos Sanches,Valerie Powell,Philip Gerretsen,Ariel Graff-Guerrero,Araba F. Chintoh,George Foussias,Gary Remington,Margaret K. Hahn,Sri Mahavir Agarwal