Correlates of weight gain during long-term risperidone treatment in children and adolescents

Abstract

BackgroundMost clinical trials of antipsychotics in children are brief, failing to address their long-term safety, particularly when taken concurrently with other psychotropics. This hypothesis-generating analysis evaluates potential correlates of weight gain in children receiving extended risperidone treatment.MethodsMedically healthy 7–17 year-old patients treated with risperidone for six months or more were enrolled. Anthropometric measurements were conducted. Developmental and medication history was obtained from the medical record. Information related to birth weight, dietary intake, physical activity, and parental weight was collected. Mixed regression analyses explored the contribution of various demographic and clinical factors to age- and sex-adjusted weight and body mass index (BMI) z scores over the treatment period.ResultsThe sample consisted of 110 patients (89% males) with a mean age of 11.8 years (sd = 2.9) upon enrollment. The majority had an externalizing disorder and received 0.03 mg/kg/day (sd = 0.02) of risperidone, for 2.5 years (sd = 1.7), to primarily target irritability and aggression (81%). Polypharmacy was common with 71% receiving psychostimulants, 50% selective serotonin reuptake inhibitors (SSRIs), and 32% α2-agonists. Weight and BMI z score were positively correlated with baseline weight at the start of risperidone, treatment duration, and the weight-adjusted dose of risperidone but inversely associated with the weight-adjusted dose of psychostimulants and the concurrent use of SSRIs and α2-agonists. The effect of risperidone dose appeared to attenuate as treatment extended while that of psychostimulants became more significant. The rate of change in weight (or BMI) z score prior to and within the first 12 weeks of risperidone treatment did not independently predict future changes neither did birth weight, postnatal growth, dietary intake, physical activity, or parental weight.ConclusionsThis comprehensive analysis exploring correlates of long-term weight (or BMI) change in risperidone-treated youths revealed that pharmacotherapy exerts significant but complex effects.Trial RegistrationNot applicable.

Risperidone-Induced Obesity in Children and Adolescents With Autism Spectrum Disorder: Genetic and Clinical Risk Factors

“…However, after adjustment for multivariate regression analysis, only the duration of risperidone treatment was found to correlate with overweight/obesity in children and adolescents (OR 1.02, 95% CI [1.01, 1.04], Bonferroni corrected p-value 0.009; Table 6). Our finding is consistent with previous studies in children and adolescents treated with risperidone (Calarge et al, 2012;Martin et al, 2004). Since the pathophysiology of risperidone-associated obesity remains poorly understood, the involvement of non-genetic factors on the risk of obesity in children and adolescents with ASD requires further evaluation.…”

Body Composition in Adolescents During Treatment With Selective Serotonin Reuptake Inhibitors

“…Furthermore, although we attempted to track symptom severity and medication adherence closely, these variables are difficult to capture accurately over extended periods of time. 51 Finally, we documented dietary information and physical activity on the basis of self-report, a method with known shortcomings. Future studies could make use of state-of-the-art methods to collect such information in real time.…”

Variation of the prevalence of pediatric polypharmacy: A scoping review

“…On the other hand, studies reporting extremely high prevalence of polypharmacy were likely to be conducted in Asia, in inpatient settings, use overlapping periods less than 31 days, or assess polypharmacy in multiple complex chronic conditions, or multiple medication classes. 5,24,[41][42][43][44][45][46][47][48][49][50][51][52] The median prevalence of polypharmacy in populations using at least one medication was much higher than that of the general population (43.4% vs 27.1%), P < 0.001. Studies that defined polypharmacy with 1 to 30 overlap days had a higher median prevalence than those with greater than 30 overlap days (37.2% vs 23.8%), but both were lower than the overall median prevalence.…”