Metabolic measures 12 months after a randomised controlled trial of treatment of clozapine associated obesity and diabetes with exenatide (CODEX)

Siskind, Dan and Russell, A. and Gamble, C. and Baker, A. and Cosgrove, P. and Burton, L. and Kisely, S. (2020) Metabolic measures 12 months after a randomised controlled trial of treatment of clozapine associated obesity and diabetes with exenatide (CODEX). Journal of Psychiatric Research, 124. pp. 9-12. ISSN 0022-3956


Abstract

Clozapine is associated with obesity and type 2 diabetes. Glucagon-like-peptide-1 (GLP-1) receptor agonists such as exenatide can counter clozapine-associated GLP-1 dysregulation. Our 24-week randomized, controlled, open-label, pilot trial of once-weekly extended-release subcutaneous exenatide or usual care (CODEX) (n = 28), found exenatide was associated with significantly greater weight loss. We examined whether this effect was maintained at 12-months post-intervention. We followed up CODEX trial participants at 12-months post trial endpoint, collecting information on weight, BMI, waist circumference, blood pressure, fasting glucose, HbA1c, and use of metformin. The primary outcome of interest was change in weight from trial baseline to 12-months post endpoint and trial endpoint to 12-months post endpoint compared between former exenatide and usual care participants. Only HbA1c differed between baseline and 12-months post endpoint between the exenatide and control groups. From endpoint to 12-month follow up there were significantly greater increases among the former exenatide versus former usual care participants for weight, BMI, HbA1c and proportion with >5% weight gain. Stratifying results by whether participants used metformin post trial did not alter proportion with >5% weight gain. Although there were no significant differences in weight and BMI between baseline and 12-month post endpoint, there were significant increases in weight and BMI in the 12 months post endpoint for the former exenatide group. This was irrespective of metformin use and is in keeping with studies of other GLP-1RA agents. Further studies on GLP-1RAs use beyond 24 weeks for people with clozapine associated weight gain are needed.


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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Faculty/School / Institute/Centre: No Faculty
Faculty/School / Institute/Centre: No Faculty
Date Deposited: 12 Jan 2022 02:02
Last Modified: 13 Jan 2022 09:17
Uncontrolled Keywords: Diabetes; GLP-1RA; Metabolic syndrome; Obesity; Schizophrenia
Fields of Research (2008): 11 Medical and Health Sciences > 1117 Public Health and Health Services > 111714 Mental Health
Fields of Research (2020): 42 HEALTH SCIENCES > 4203 Health services and systems > 420313 Mental health services
42 HEALTH SCIENCES > 4203 Health services and systems > 420309 Health management
42 HEALTH SCIENCES > 4203 Health services and systems > 420314 Multimorbidity
Socio-Economic Objectives (2020): 20 HEALTH > 2004 Public health (excl. specific population health) > 200409 Mental health
20 HEALTH > 2004 Public health (excl. specific population health) > 200411 Overweight and obesity
Identification Number or DOI: https://doi.org/10.1016/j.jpsychires.2020.02.015
URI: http://eprints.usq.edu.au/id/eprint/45382

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