Weight Gain, Treatment Interruptions Reported With Second-Generation Antipsychotics for Schizophrenia, Bipolar 1 Disorder

The following article is a part of conference coverage from Psych Congress 2020 Virtual Experience, held virtually from September 10 to 13, 2020. The team at Psychiatry Advisor will be reporting on the latest news and research conducted by leading experts in psychiatry. Check back for more from the Psych Congress 2020.

 

Treatment interruptions and clinically significant weight gain were found to occur quickly following the initiation of second-generation antipsychotic agents associated with moderate to high risk of weight gain among patients with schizophrenia and bipolar 1 disorder, and the majority of these patients did not return to their pretreatment weight, according to study results presented at Psych Congress 2020 Virtual Experience, held September 10 to 13.

Patients included in this study had schizophrenia (n=8174) or bipolar 1 disorder (n=9142) prior to or within 30 days of starting treatment with a second-generation antipsychotic. The median follow-up duration for patients with schizophrenia was 153.4 weeks, and the median follow-up duration for patients with bipolar 1 disorder was 159.4 weeks. The mean ages of patients in the schizophrenia and bipolar groups were 57.4 and 48.2 years, respectively.

All patients had linked electronic medical records and claims data for ≥12 months prior to and ≥12 months after the index date (ie, the date of a new ordered/filled prescription for a second-generation antipsychotic medication associated with moderate to high risk of weight gain). Patients had at least 1 weight measurement documented in the 12 months before or including the index date and at least 1 weight measurement documented in the 3 months after the index date.

An outcome of this study included changes in body weight, including the proportion of patients with clinically significant weight gain of ≥7% and ≥10% from baseline body weight. Another outcome was treatment interruptions, including switches or discontinuations.

The most commonly used antipsychotic medications (other than second-generation antipsychotics) at baseline were antidepressants (schizophrenia and bipolar 1 disorder: 62.8% and 69.7%, respectively), antianxiety medications (38% and 46.4%), and mood stabilizers (16.8% and 23.1%).

At baseline, 45.5% of patients with schizophrenia and 50.7% with bipolar 1 disorder were obese. Approximately 12% of all patients experienced clinically significant weight gain within 3 months of initiation of treatment with a second-generation antipsychotic. In a group of patients receiving treatment with second-generation antipsychotics for >6 months, approximately 28% of those with schizophrenia and 30% of those with bipolar 1 disorder experienced clinically significant weight gain during the follow-up period. The median time to clinically significant weight gain was 14 weeks. No numerical differences in weight gain were observed between patient groups.

The majority of patients (>96%) experienced treatment interruptions during the follow-up period. The median time to treatment interruptions was 12 weeks for patients with schizophrenia and 13 weeks for patients with bipolar 1 disorder. Approximately 74% of patients with clinically significant weight gain and treatment interruptions did not return to their pretreatment weight. The remaining patients returned to their baseline weight over a median duration of 38 weeks (schizophrenia) and 39 weeks (bipolar 1 disorder) after treatment interruptions.

Limitations of this study include the measurement of outcomes over irregular intervals as well as the lack of data on patients’ actual medication use vs medications ordered and prescriptions filled.

Disclosure: This clinical trial was supported by Alkermes. Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Reference

Doane M, Bessonova L, Mortimer K, et al. Weight gain and treatment interruptions with second-generation oral antipsychotics: analysis of real-world data among patients with schizophrenia or bipolar I disorder. Presented at: Psych Congress 2020 Virtual Experience; September 10-13, 2020. Poster 214.