Adjunctive metformin for antipsychotic-induced dyslipidemia: a meta-analysis of randomized, double-blind, placebo-controlled trials

Wen Long Jiang, Dong Bin Cai, Fei Yin, Ling Zhang, Xi Wu Zhao, Jie He, Chee H. Ng, Gabor S. Ungvari, Kang Sim, Mei Ling Hu, Wei Zheng, Yu Tao Xiang

Research output: Contribution to journalReview article

Abstract

Antipsychotic-induced dyslipidemia could increase the risk of cardiovascular diseases. This is a meta-analysis of randomized double-blind placebo-controlled trials to examine the efficacy and safety of adjunctive metformin for dyslipidemia induced by antipsychotics in schizophrenia. The standardized mean differences (SMDs) and risk ratios (RRs) with their 95% confidence intervals (CIs) were calculated using the random-effects model with the RevMan 5.3 version software. The primary outcome was the change of serum lipid level. Twelve studies with 1215 schizophrenia patients (592 in metformin group and 623 in placebo group) were included and analyzed. Adjunctive metformin was significantly superior to placebo with regards to low density lipoprotein cholesterol (LDL-C) [SMD: −0.37 (95%CI:−0.69, −0.05), P = 0.02; I2 = 78%], total cholesterol [SMD: −0.47 (95%CI:−0.66, −0.29), P < 0.00001; I2 = 49%], triglyceride [SMD: −0.33 (95%CI:−0.45, −0.20), P < 0.00001; I2 = 0%], and high density lipoprotein cholesterol [SMD: 0.29 (95%CI:0.02, 0.57), P = 0.03; I2 = 69%]. The superiority of metformin in improving LDL-C level disappeared in a sensitivity analysis and 80% (8/10) of subgroup analyses. Metformin was significantly superior to placebo with regards to decrease in body weight, body mass index, glycated hemoglobin A1c, fasting insulin, and homeostasis model assessment-insulin resistance (P = 0.002–0.01), but not regarding changes in waist circumference, waist-to-hip rate, leptin, fasting glucose, and blood pressure (P = 0.07–0.33). The rates of discontinuation due to any reason [RR: 0.97 (95%CI: 0.66, 1.43), P = 0.89; I2 = 0%] was similar between the two groups. Adjunctive metformin could be useful to improve total cholesterol and triglyceride levels, but it was not effective in improving LDL-C level in schizophrenia.

Original languageEnglish
Article number117
JournalTranslational Psychiatry
Volume10
Issue number1
DOIs
Publication statusPublished - 1 Dec 2020

Fingerprint Dive into the research topics of 'Adjunctive metformin for antipsychotic-induced dyslipidemia: a meta-analysis of randomized, double-blind, placebo-controlled trials'. Together they form a unique fingerprint.

  • Cite this

    Jiang, W. L., Cai, D. B., Yin, F., Zhang, L., Zhao, X. W., He, J., Ng, C. H., Ungvari, G. S., Sim, K., Hu, M. L., Zheng, W., & Xiang, Y. T. (2020). Adjunctive metformin for antipsychotic-induced dyslipidemia: a meta-analysis of randomized, double-blind, placebo-controlled trials. Translational Psychiatry, 10(1), [117]. https://doi.org/10.1038/s41398-020-0785-y