Étude comparative des effets métaboliques des antipsychotiques de seconde génération chez les enfants et les adolescents selon leur utilisation en monothérapie ou en poly-thérapie : étude rétrospective sur 24 mois
Second generation antipsychotics (SGA) can induce metabolic changes such as weight gain, glucose abnormalities and dyslipidemia. In the pediatric population, studies analysing the SGA polytherapy (switch of SGA and/or combination of two SGA) induced metabolic effects are scarce and, to our knowledge, no naturalistic study, until now, directly compared metabolic changes between the SGA monotherapy (a single SGA prescribed during the follow-up) and SGA polytherapy use. The objective of this retrospective study is to compare SGA monotherapy induced metabolic changes to those secondary to SGA polytherapy. To this end, from 147 antipsychotic-naïve children and adolescents (mean age 12.8 years; 95% CI 9.8 to 15.9) selected between November 2005 and June 2013, 116 (78.9%) received a SGA monotherapy and 31 (21.1%) a SGA polytherapy. We used the linear mixed model to compare weight, body mass index adjusted for age and sex (BMI z score) and fasting glucose changes between the two SGA treatment groups with the repeated factor the time relative to baseline at 1, 3, 6, 12 and 24 months. Our results show that the type of therapy (monotherapy or polytherapy) did not have a significant impact on the metabolic changes between the two groups. Overall, after 24 months of SGA treatment, mean weight increased significantly by 12.8 kg (95% CI 10.4 to 15.0), BMI z score by 0.44 (95% CI 0.21 to 0.68), fasting glucose levels by 0.29 mmol/l (95% CI 0.11 to 0.47). Incidence of overweight/obese was 22.6%, BMI z score increase over 0.5 was 9.4%, glucose intolerance was 9.4% and type II diabetes was 3.1%. In conclusion, our study confirms the significant risk of metabolic complications during 24 months SGA treatment, without a significant difference between monotherapy and polytherapy use.
adolescents Second generation antipsychotics Children Weight gain Obesity Glucose abnormalities Type II diabetes