Monday, June 12, 2017

Adjunctive Liraglutide Found to Reduce Weight Gain, Metabolic Effects From Clozapine, Olanzapine

Patients with schizophrenia who experience weight gain and metabolic disturbances while taking clozapine or olanzapine may benefit from once-daily adjunctive treatment with the anti-diabetic medication liraglutide, reports a study published June 10 in JAMA Psychiatry.

“In overweight or obese patients with schizophrenia spectrum disorders and prediabetes, 16 weeks of liraglutide as an adjunctive treatment to stable treatment with clozapine or olanzapine significantly improved glucose tolerance and glycemic control. At the end of the trial, the placebo-subtracted body weight loss was 5.3 kg,” wrote Anders Fink-Jensen, D.M.Sc., of the University of Copenhagen and colleagues. Liraglutide is a glucagon-like peptide-1 receptor agonist approved for the treatment of type 2 diabetes and obesity. 

These findings are encouraging for patients taking these antipsychotics, which are among the most effective for treating schizophrenia but also have the greatest risk of cardiovascular and metabolic side effects, according to the authors.

The study included 103 adults aged 18 to 65 who were diagnosed with a schizophrenia spectrum disorder (schizoaffective disorder excluded) and were receiving stable treatment with clozapine or olanzapine. The participants, who all had prediabetes and a body mass index of 27 or greater, were randomly assigned to 16 weeks of once-daily treatment with subcutaneously injected liraglutide (up to 1.8 mg) or placebo provided in prefilled pen injectors. Every four weeks, participants had blood samples obtained; body weight, waist circumference, and blood pressure measured; and adverse events and alcohol consumption recorded. 

After 16 weeks, patients taking liraglutide had a 23% larger reduction in their two-hour plasma glucose level compared with the placebo group. In the liraglutide group, 30 patients (63.8%) changed status from prediabetes to normal glucose tolerance compared with eight (16.0%) in the placebo group.

Additional benefits observed in the liraglutide group included decreased waist circumference, systolic blood pressure, and low-density lipoprotein cholesterol levels.

Patients in the liraglutide group experienced significantly higher rates of nausea (31 of 50 [62%] vs. 16 of 50 [32%]), but these differences diminished over time, the authors noted.

“Altogether, the liraglutide group experienced significantly fewer serious adverse events, with exacerbation of patients’ psychiatric disease being the most common cause, and no differences in quality of life, daily functioning, or psychiatric disease severity were found,” the authors added.

For related information, see the Psychiatric News article “Aripiprazole May Reduce Some Side Effects of Antipsychotics in Women.” 

(Image: forestpath/Shutterstock)


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