Predicting antipsychotic-induced weight gain in first episode psychosis-a protocol for a field-wide systematic review of prognostic factor studies

Abstract

<p><strong>Background:</strong> One significant complexity associated with management of antipsychotic-induced weight gain (AIWG) is extensive interindividual variability amongst patients in initial susceptibility to AIWG, time to plateau of weight gain, and resultant final amount of weight gained. Prior to antipsychotic commencement, risk-stratified information highlighting those at increased risk of experiencing significant AIWG would allow tailored weight monitoring and subsequent management protocols to be developed.</p><p><strong>Methods: </strong>This protocol is for a planned systematic review to identify the current utility of baseline clinical, sociodemographic, and biological prognostic factors in predicting the likelihood of significant AIWG occurring prior to antipsychotic commencement. The cohort assessed will be antipsychotic-naïve adults with a first episode of psychosis. Searches for both randomised and prospective non-randomised studies will be undertaken by searching four electronic databases and two trial registers, followed by reference searching, forward citation searching and liaison with content experts. A meta-analysis of study results will be undertaken where study quality and homogeneity allow. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework modified for prognostic research will be used to assess evidence certainty. This protocol was prepared in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Protocols guideline and latest guidance from the Prognosis Methods Group of the Cochrane Collaboration.</p><p><strong>Results: </strong>This review will establish the current quantity, quality and clinical utility of evidence addressing the prognostic association of clinical, biological, and sociodemographic factors in prospectively identifying those more likely to experience significant AIWG.</p><p><strong>Registration details:</strong> PROSPERO registration number CRD42021258148.</p>

Predicting antipsychotic-induced weight gain in first episode psychosis – A field-wide systematic review and meta-analysis of non-genetic prognostic factors

“…The protocol was registered on PROSPERO (CRD42021258148) and published separately [ 14 ]. A detailed outline of review methods is contained within the protocol and a brief description only is provided here.…”

“…Data extraction was undertaken using a version of the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies – Modified for Prognostic Factor Studies (CHARMS-PF) [ 16 ]. The modified checklist can be found in the study protocol [ 14 ]. We extracted all unadjusted and adjusted measures of association and variance estimates from each study.…”

“…Outcomes Primary outcomes -Relationship between one or more non-genetic prognostic factor and mean change in weight (kg) following antipsychotic commencement -Relationship between one or more non-genetic prognostic factor and mean change in body mass index (BMI) following antipsychotic commencement -Relationship between one or more non-genetic prognostic factor and likelihood of experiencing clinically significant weight gain following antipsychotic commencement. Clinically significant weight gain is most commonly defined as a ≥ 7% increase in body weight [14], but we accepted studies where this outcome is defined as a ≥ 5% increase Secondary outcomes:…”

Informing the development of antipsychotic-induced weight gain management guidance: patient experiences and preferences – qualitative descriptive study

“…Participants requested greater clinician education on the uniqueness of weight gain induced by antipsychotic treatment, specifically interference with homeostatic mechanisms mediating appetite control and the heterogenous nature of its severity. 39 Given its impact on AIWG prognosis, 40 participants described a fundamental aspect of managing AIWG being collaborative decision-making in antipsychotic treatment choices. The decision to change antipsychotic involves consideration of risk by both prescribers and patients.…”

“…8 Although inter-individual variability in the prognosis of AIWG is an important factor, limited management guidance for clinicians invariably increases management complexity. 7,9,10 Although a very limited number of recommendations exist within larger guidelines, [11][12][13] a rigorously developed clinical practice guideline dedicated to AIWG management is notably absent. 10 This includes guidance informed by consultation with varying stakeholder groups, and recommendation development to align with international standards.…”