Comparative Effects of Antipsychotics on Metabolic and Endocrine Function in Children and Young People With Schizophrenia: A Systematic Review and Network Meta-Analysis

Aims Antipsychotic treatment is associated with metabolic disturbance, clear differences observed between drugs in the adult population. However, degree to which alterations occur different antipsychotics children and adolescents unclear. As such, we aimed compare rank based on their endocrine side-effects when used of schizophrenia this age Methods We searched MEDLINE, EMBASE, PsycINFO from inception until October 30, 2022. included double blinded, randomised controlled trials comparing 12 placebo acute individuals aged <18 years. performed random-effects network meta-analyses investigate treatment-induced changes body weight, BMI, total cholesterol, LDL HDL triglycerides, glucose, prolactin concentrations. meta-regressions examine relationship metabolic/endocrine change age, sex, ethnicity Results Of 6697 citations, 15 trials, consisting 2501 patients. Antipsychotics analyses were aripiprazole, asenapine, blonanserin, clozapine, haloperidol, lurasidone, molindone, olanzapine, paliperidone, quetiapine, risperidone, ziprasidone. Median duration was 6 weeks (IQR 6-12). Mean 15.13 (SD 0.94) for weight gain compared ranged -2.04 kg (95% CI -4.24 0.17) molindone 4.11 (-0.55 8.77) clozapine; BMI -0.55 kg/m2 (-1.37 0.27) 1.92 (0.16 3.68) quetiapine; cholesterol -0.14 mmol/L (-0.70 0.41) risperidone/paliperidone 0.46 (0.00 0.90) -0.32 mmol (-0.76 0.12) aripiprazole 0.24 (-0.15 0.63) olanzapine; 0.10 (-0.05 0.26) -0.23 (-0.52 0.06) risperidone/paliperidone; triglycerides -0.01 (-0.21 0.34) 0.62 (0.04 1.2) glucose -0.33 (-0.64 -0.02) ziprasidone 0.81 (0.28 1.34) -1.92 ng/mL (-15.37 11.53) 28.10 (16.23 39.96) risperidone/paliperidone. Higher baseline predicted by greater increases (p = 0.014). Conclusion found significant terms adolescents. Treatment guidelines should be updated reflect our findings. choice antipsychotic made an individual basis, considering clinical circumstances preferences young people, carers, clinicians.