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Metabolic and endocrine adverse effects of second-generation antipsychotics in children and adolescents: A systematic review of randomized, placebo controlled trials and guidelines for clinical practice

Published online by Cambridge University Press:  16 April 2020

M. De Hert ,
M. Dobbelaere ,
E.M. Sheridan ,
D. Cohen  and
C.U. Correll
M. De Hert*
Affiliation:
Centre Catholic University Leuven, campus Kortenberg, Leuvensesteenweg 517, 3070Kortenberg, Belgium
M. Dobbelaere
Affiliation:
Psychiatric Centre Catholic, University Leuven, campus Gasthuisberg, Gasthuisberg, Belgium
E.M. Sheridan
Affiliation:
The Zucker Hillside Hospital, Glen Oaks, New York, USA
D. Cohen
Affiliation:
Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Netherlands Division Chronic Care, Noord-Holland-Noord, GGZ-NHN, Heerhugowaard, Netherlands
C.U. Correll
Affiliation:
The Zucker Hillside Hospital, Glen Oaks, New York, USA Albert Einstein College of Medicine, Bronx, New York, USA
*
*Corresponding author. Tel.: +32 2 758 05 11. E-mail address: [email protected] (M. De Hert).
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Abstract

Second-generation antipsychotics (SGA) are being used more often than ever before in children and adolescents with psychotic and a wide range of non-psychotic disorders. Several SGA have received regulatory approval for some paediatric indications in various countries, but off-label use is still frequent. The aim of this paper was to perform a systematic review and critically evaluate the literature on cardiometabolic and endocrine side-effects of SGA in children and adolescents through a Medline/Pubmed/Google Scholar search of randomized, placebo controlled trials of antipsychotics in children and adolescents (<18 years old) until February 2010. In total, 31 randomized, controlled studies including 3595 paediatric patients were identified. A review of these data confirmed that SGA are associated with relevant cardiometabolic and endocrine side-effects, and that children and adolescents have a high liability to experience antipsychotic induced hyperprolactinaemia, weight gain and associated metabolic disturbances. Only weight change data were sufficiently reported to conduct a formal meta-analysis. In 24 trials of 3048 paediatric patients with varying ages and diagnoses, ziprasidone was associated with the lowest weight gain (−0.04 kg, 95% confidence interval [CI]: −0.38 to +0.30), followed by aripiprazole (0.79 kg, 95% CI: 0.54 to 1.04], quetiapine (1.43 kg, 95% CI: 1.17 to 1.69) and risperidone (1.76 kg, 95% CI: 1.27 to 2.25) were intermediate, and olanzapine was associated with weight gain the most (3.45 kg, 95% CI: 2.93 to 3.97). Significant weight gain appeared to be more prevalent in patients with autistic disorder who were also younger and likely less exposed to antipsychotics previously. These data clearly suggest that close screening and monitoring of metabolic side effects is warranted and that the least cardiometabolically problematic agents should be used first whenever possible. A good collaboration between child- and adolescent psychiatrists, general practitioners and paediatricians is essential to maximize overall outcomes and to reduce the likelihood of premature cardiovascular morbidity and mortality.

Keywords

AdolescentsAntipsychoticsCardiovascular diseaseChildrenDiabetesGuidelinesManagementMonitoringSide-effectsWeight gain
Type
Review
Information
European Psychiatry , Volume 26 , Issue 3 , April 2011 , pp. 144 - 158
Copyright
Copyright © Elsevier Masson SAS 2011

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