Controversies regarding lithium-associated weight gain: case–control study of real-world drug safety data

International Journal of Bipolar Disorders

Brief Report

Bruno Müller-Oerlinghausen¹  Eckart Rüther²  Waldemar Greil³  Georgios Schoretsanitis⁴  Stefan Bleich⁵  Sermin Toto⁵  Johanna Seifert⁵  Andreas Erfurth⁶  Nadja Nievergelt⁷  Mateo de Bardeci⁸  Hans Stassen⁹  Katja Cattapan^1,10  Gregor Hasler^1,11 

[1] Charité Universitätsmedizin-Berlin, Berlin, Germany;Medical Faculty Brandenburg Theodor Fontane, Neuruppin, Germany;Drug Commission of the German Medical Association, Berlin, Germany;Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Nussbaumstr. 7, 80331, Munich, Germany;Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Nussbaumstr. 7, 80331, Munich, Germany;Psychiatric Private Hospital, Sanatorium Kilchberg, Zurich, Switzerland;Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland;The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA;Department of Psychiatry at the Donald and Barbara Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA;Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany;Klinik Hietzing, 1st Department of Psychiatry and Psychotherapeutic Medicine, Vienna, Austria;Psychiatric Private Hospital, Sanatorium Kilchberg, Zurich, Switzerland;Psychiatric Private Hospital, Sanatorium Kilchberg, Zurich, Switzerland;Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland;Psychiatric Private Hospital, Sanatorium Kilchberg, Zurich, Switzerland;Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland;IFMA Preventive Health Management Inc., 80 Pine Street, 24th Floor, 10005, New York, NY, USA;Psychiatric Private Hospital, Sanatorium Kilchberg, Zurich, Switzerland;University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland;Psychiatry Research Unit, University of Fribourg, Fribourg, Switzerland;

关键词: Weight gain;    Lithium;    Mood stabilizer;    Adverse drug reaction (ADR);    Case–control study;    Drug safety;    Pharmacovigilance;   

DOI  :  10.1186/s40345-023-00313-8

 received in 2023-07-04, accepted in 2023-09-27,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe impact of long-term lithium treatment on weight gain has been a controversial topic with conflicting evidence. We aim to assess reporting of weight gain associated with lithium and other mood stabilizers compared to lamotrigine which is considered free of metabolic adverse drug reactions (ADRs).MethodsWe conducted a case/non-case pharmacovigilance study using data from the AMSP project (German: “Arzneimittelsicherheit in der Psychiatrie”; i.e., Drug Safety in Psychiatry), which collects data on ADRs from patients treated in psychiatric hospitals in Germany, Austria, and Switzerland. We performed a disproportionality analysis of reports of weight gain (> 10% of baseline body weight) calculating reporting odds ratio (ROR). We compared aripiprazole, carbamazepine, lithium, olanzapine, quetiapine, risperidone, and valproate to lamotrigine. Additional analyses related to different mood stabilizers as reference medication were performed. We also assessed sex and age distributions of weight-gain reports.ResultsWe identified a total of 527 cases of severe drug-induced weight gain representing 7.4% of all severe ADRs. The ROR for lithium was 2.1 (95%CI 0.9–5.1, p > 0.05), which did not reach statistical significance. Statistically significant disproportionate reporting of weight gain was reported for olanzapine (ROR: 11.5, 95%CI 4.7–28.3, p < 0.001), quetiapine (ROR: 3.4, 95%CI 1.3–8.4, p < 0.01), and valproate (ROR: 2.4, 95%CI 1.1–5.0, p = 0.03) compared to lamotrigine. Severe weight gain was more prevalent in non-elderly (< 65 years) than in elderly patients, with an ROR of 7.6 (p < 0.01) in those treated with lithium, and an ROR of 14.7 (p < 0.01) in those not treated with lithium.ConclusionsOur findings suggest that lithium is associated with more reports of severe weight gain than lamotrigine, although this difference did not reach statistical significance. However, lithium use led to fewer reports of severe weight gain than some alternative drugs for long-term medication (olanzapine, quetiapine, and valproate), which is consistent with recent studies. Monitoring of weight gain and metabolic parameters remains essential with lithium and its alternatives.

【 授权许可】

CC BY   
© Springer-Verlag GmbH Germany, part of Springer Nature 2023

【 图 表 】

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Fig. 1