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

Article


Siskind, Dan, Russell, A., Gamble, C., Baker, A., Cosgrove, P., 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. https://doi.org/10.1016/j.jpsychires.2020.02.015
Article Title

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

ERA Journal ID13098
Article CategoryArticle
AuthorsSiskind, Dan (Author), Russell, A. (Author), Gamble, C. (Author), Baker, A. (Author), Cosgrove, P. (Author), Burton, L. (Author) and Kisely, S. (Author)
Journal TitleJournal of Psychiatric Research
Journal Citation124, pp. 9-12
Number of Pages4
Year2020
Place of PublicationUnited Kingdom
ISSN0022-3956
1879-1379
Digital Object Identifier (DOI)https://doi.org/10.1016/j.jpsychires.2020.02.015
Web Address (URL)https://www.sciencedirect.com/science/article/pii/S0022395619311355
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.

KeywordsDiabetes; GLP-1RA; Metabolic syndrome; Obesity; Schizophrenia
ANZSRC Field of Research 2020420313. Mental health services
420309. Health management
420314. Multimorbidity
Byline AffiliationsDepartment of Health, Queensland
University of Queensland
Queensland Centre for Mental Health Research, Australia
Institution of OriginUniversity of Southern Queensland
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