Metformin promising for weight loss among adolescents on second-generation antipsychotics

United States: A recently published study has concluded that Metformin is beneficial for managing weight gain in those children and adolescents treated with second-generation antipsychotics.

The findings of the study are published in Frontiers in Psychiatry.

The lead author of the research article is Dr Mansuri from the Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States.

Research says that 14% of children (11 years old) experience psychotic symptoms, which leads to a nearly 5 to 16 times increased psychotic illness rate during early adulthood.

Antipsychotic medications are recommended treatment per the American Psychiatric Association (APA) guidelines.

First-generation antipsychotics are effective but have side effects.

Second-generation antipsychotics are preferred due to their superior efficacy, but they cause weight gain problems in children. This becomes a significant limiting factor.

Childhood obesity is a growing epidemic and increases the risk of cardiovascular, metabolic, and psychiatric disorders. This necessitates timely intervention, even if drugs induce it.

Metformin, a biguanide drug for managing type 2 diabetes, causes weight reduction, and there are studies favouring the benefits in patients with antipsychotic-induced weight gain and metabolic abnormalities.

Metformin is effective, safe, and favourable choice.

There needs to be more data in the context of children and adult populations.

Considering this, a study was conducted by a team of researchers from the Department of Psychiatry at Boston Children's Hospital and Harvard Medical School and AtlantiCare Health System, Egg Harbor Township, NJ, United States. The co-researcher was Dr Makani.

The study aimed to determine the question,

What is the efficacy and safety of metformin weight gain management in children and young adults treated with second-generation antipsychotics?

The study methods and results could be summarised as follows:

• PRISMA guidelines were followed to evaluate studies (before March 2020).

• The databases searched were Medline, Google Scholar, PubMed, Cochrane library, annual scientific sessions of the American Psychiatric Association, American Academy of Child and Adolescent, Psychiatry, and American Society of Clinical Psychopharmacology.

• The Studies involving the comparison of Metformin with the placebo were analyzed.

• The assessment was made for anthropometric-biochemical parameter changes, rate of drug discontinuation and side effects.

• The meta-analysis used the random-effects method.

• The final analysis involved four studies.

• There was a total of 213 patients.

• One hundred six patients were in Metformin, and 107 were in the control group.

• 12–16 weeks of metformin therapy caused a significant reduction in weight after pooled analysis.

• The mean difference was −4.53 lbs.

• The p-value was 0.004.

• Metformin significantly reduced insulin resistance with a value of −1.38 and a p-value of 0.002.

• Nausea-vomiting had higher odds with an OR of 4.07 and a p-value of 0.02 in the metformin group.

• The OR for diarrhoea was 2.93, with a p-value of 0.002 in the metformin group.

• No difference was recorded in the drug discontinuation rate, with an OR of 1.45 and a p-value of 0.56.

The researchers have explained that,

Metformin is beneficial for treating such children. Our meta-analysis is the first one to focus on Metformin's efficacy and safety. There was a significant reduction in BMI Z-score and weight in 12–16 weeks. The results are promising, but larger studies must be conducted to conclude.

Our study had limitations like smaller sample sizes, different doses and duration of Metformin in each study, etc. They said.

The results of our study will further aid in designing future randomized clinical trials with a large patient population.

Further reading:

Mansuri Z, Makani R, Trivedi C, Adnan M, Vadukapuram R, Rafael J, Lodhi A and Reddy A (2022) The role of Metformin in treatment of weight gain associated with atypical antipsychotic treatment in children and adolescents: A systematic review and meta-analysis of randomized controlled trials. Front. Psychiatry 13:933570. doi: 10.3389/fpsyt.2022.933570