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  • CoMET: a randomised controlled trial of co-commencement of metformin versus placebo as an adjunctive treatment to attenuate weight gain in patients with schizophrenia newly commenced on clozapine

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    Suetani519538-Published.pdf (422.1Kb)
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    Version of Record (VoR)
    Author(s)
    Siskind, Dan
    Russell, Anthony W
    Suetani, Shuichi
    Flaws, Dylan
    Kisely, Steve
    Moudgil, Vikas
    Northwood, Korinne
    Robinson, Gail
    Scott, James G
    Stedman, Terry
    Warren, Nicola
    Winckel, Karl
    Cosgrove, Peter
    Baker, Andrea
    Griffith University Author(s)
    Suetani, Shuichi
    Year published
    2021
    Metadata
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    Abstract
    Background: There is limited evidence on interventions to minimise weight gain at clozapine commencement. We compared the effect of adjunctive metformin versus placebo at clozapine initiation. Methods: People with schizophrenia commencing on clozapine were randomised to either metformin or placebo for 24 weeks. The primary outcome was difference in the change of body weight. Secondary outcomes included comparative rates of weight gain of more than 5%, overall weight gain/loss, and differences in metabolic and psychosis outcomes. Results: The study was closed prematurely in March 2020 due to COVID-19 restrictions. Ten ...
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    Background: There is limited evidence on interventions to minimise weight gain at clozapine commencement. We compared the effect of adjunctive metformin versus placebo at clozapine initiation. Methods: People with schizophrenia commencing on clozapine were randomised to either metformin or placebo for 24 weeks. The primary outcome was difference in the change of body weight. Secondary outcomes included comparative rates of weight gain of more than 5%, overall weight gain/loss, and differences in metabolic and psychosis outcomes. Results: The study was closed prematurely in March 2020 due to COVID-19 restrictions. Ten participants were randomised to each of the metformin and placebo groups. Eight metformin group and five placebo group participants completed the trial and were included in the analysis. The study was insufficiently powered to detect difference between the metformin and placebo groups for the primary outcome of change in weight (0.09 kg vs 2.88 kg, p = 0.231). In terms of secondary outcomes, people in the metformin group were significantly less likely to gain >5% of their body weight (12.5% vs 80%, p = 0.015) and were more likely to lose weight (37.5% vs 0% p = 0.024) compared to placebo. There was no difference between the groups in terms of adverse drug reactions (ADRs). Conclusion: While limited by the forced premature closure of the trial due to COVID19, the findings from this randomised controlled trial are promising. Clozapine and metformin co-commencement may be a promising treatment to prevent clozapine-associated weight gain, especially given the low rates of ADRs associated with metformin. This supports the consideration of use of metformin to prevent weight gain in people initiated on clozapine; however, further studies are needed to confirm this finding. Trial registration: ACTRN12617001547336.
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    Journal Title
    Therapeutic Advances in Psychopharmacology
    Volume
    11
    DOI
    https://doi.org/10.1177/20451253211045248
    Copyright Statement
    © The Author(s), 2021. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
    Subject
    Psychopharmacology
    Science & Technology
    Life Sciences & Biomedicine
    Pharmacology & Pharmacy
    Psychiatry
    clozapine
    Publication URI
    http://hdl.handle.net/10072/409934
    Collection
    • Journal articles

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