AUTHOR=Mansuri Zeeshan , Makani Ramkrishna , Trivedi Chintan , Adnan Mahwish , Vadukapuram Ramu , Rafael John , Lodhi Ashutosh , Reddy Abhishek 

TITLE=The role of metformin in treatment of weight gain associated with atypical antipsychotic treatment in children and adolescents: A systematic review and meta-analysis of randomized controlled trials

JOURNAL=Frontiers in Psychiatry

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2022.933570

DOI=10.3389/fpsyt.2022.933570

ISSN=1664-0640

ABSTRACT=Introduction: 
Second-generation antipsychotics are associated with significant weight gain. The meta-analysis was performed for published randomized studies of Metformin for the treatment of weight gain in children and young adults treated with second-generation antipsychotics.
Methods:
Search was performed for the randomized studies which evaluated the effect of Metformin on the treatment of weight gain in children and adolescents undergoing treatment with second-generation antipsychotics. From all the studies, data were collected for change in anthropometric-biochemical parameters, drug discontinuation rate, and side effects among the groups. The random-effects method was used for meta-analysis. 
Results:
Four studies with were included in the final analysis (213 patients; metformin:106; control:107). After pooled analysis, 12-16 weeks of metformin therapy was associated with a significant reduction in weight (mean difference (MD): -4.53 lbs, p-value <0.001), and BMI z score [MD, -0.09, p-value:0.004] compared to control. Metformin was also associated with a significant reduction in insulin resistance [MD: -1.38, p-value:0.002]. There were higher odds of nausea-vomiting [OR: 4.07, p-value: 0.02] and diarrhea [OR: 2.93, p-value: 0.002] in the metformin group. However, there was no difference in drug discontinuation rate [OR: 1.45, p-value: 0.56].
Conclusions:
Metformin may prove beneficial in the treatment of weight gain in children treated with second-generation antipsychotics. The pooled treatment effect showed a significant reduction in BMI Z-score and weight in just 12-16 weeks. The limitations include small sample size, variation in metformin dose, and duration of treatment. This meta-analysis should be interpreted as promising, and further larger studies are warranted before drawing a conclusion.