Medication choice may affect weight gain when initiating antidepressant treatment

Embargoed for release until 5:00 p.m. ET on Monday 1 July 2024     

Annals of Internal Medicine Tip Sheet      

@Annalsofim     
Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.     
----------------------------     

1. Medication choice may affect weight gain when initiating antidepressant treatment

Bupropion associated with least weight gain among 8 first-line antidepressants

Abstract: https://www.acpjournals.org/doi/10.7326/M23-2742 

URL goes live when the embargo lifts        

A target trial emulation study found small differences in short- and longer-term mean weight change among patients initiating treatment with one of 8 first-line antidepressants. Among the medications included in the trial, bupropion was consistently associated with the least weight gain. These findings are important because patient concerns about weight gain may affect medication adherence.  The study is published in Annals of Internal Medicine.

Researchers from Harvard Medical School and Harvard Pilgrim Health Care Institute studied electronic health records for more than 183,000 adults initiating treatment with one of 8 first-line antidepressants to assess changes in weight by medication at 6, 12, and 24 months after participants started taking it. Medications studied included the commonly prescribed sertraline, citalopram, bupropion, escitalopram, fluoxetine, venlafaxine, paroxetine, and duloxetine.  The researchers found differences in medication-induced weight gain both within and between antidepressant subclasses. At 6 months, users of escitalopram, paroxetine, and duloxetine gained approximately 0.3 to 0.4 kg more weight and were 10% to 15% more likely to gain at least 5% of their baseline weight than sertraline users. Bupropion users gained 0.22 kg less weight and were 15% less likely to gain at least 5% of their baseline weight than sertraline users. Fluoxetine use was not associated with 6-month weight change compared with sertraline use. According to the study authors, clinicians and patients may wish to consider these differences when making decisions about which specific antidepressant to start, especially for patients who are concerned about weight gain.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author, Joshua Petimar, ScD, please contact the Harvard media relations office at Institute_Communications@hphci.harvard.edu.

----------------------------     

2. Acupuncture may relieve pain-specific disability in people with spinal stenosis

Abstract: https://www.acpjournals.org/doi/10.7326/M23-2749          

URL goes live when the embargo lifts        

A randomized clinical trial across 5 hospitals in China found that acupuncture may relieve pain-specific disability among patients with degenerative lumbar spinal stenosis (DLSS) and predominantly neurogenic claudication, pain in the buttocks and/or legs that is aggravated by walking or prolonged standing. These findings are important because DLSS can result in functional limitation in daily activities as well as negative psychological effects and effective treatments are limited. The findings are published in Annals of Internal Medicine.

Researchers from Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Bejing randomly assigned 196 patients to either 18 sessions of acupuncture or sham acupuncture over 6 weeks to investigate the effect of acupuncture on pain and disability symptoms of DLSS as measured by modified Roland–Morris Disability Questionnaire (RMDQ) score, with 24-week follow-up after treatment. There were 98 participants in each group and the mean modified RMDQ score was 12.6 in the acupuncture group and 12.7 in the sham acupuncture group at baseline. At 6 weeks, modified RMDQ score decreased to 8.1 and 9.5, respectively, meaning that acupuncture resulted in a 43.3% greater improvement in pain-specific symptoms.  According to the study authors, follow-up indicated that effects of acupuncture may last 24 weeks.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Zhishun Liu, MD, PhD, please contact Yuanjie Sun at puzhisun@163.com.

----------------------------     

3. Either ACEi or ARB therapy protect against kidney failure in those with advanced CKD

Neither therapy provided a death benefit for those with late-stage CKD

Abstract: https://www.acpjournals.org/doi/10.7326/M23-3236          

URL goes live when the embargo lifts        

A systematic review and retrospective individual participant-level meta-analysis of 18 trials comprised of more than 1,700 participants found that initiating treatment with an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin-receptor blocker (ARB) protects against kidney failure in patients with advanced chronic kidney disease (CKD). Neither therapy provided a death benefit. The findings are published in Annals of Internal Medicine.

Researchers from the University of California, San Francisco and Tufts Medical Center conducted an individual level analysis of 18 trials to examine the association of ACEi or ARB treatment initiation, relative to a non–ACEi or ARB comparator, with rates of kidney failure and death. The data showed that the risk for progression to kidney failure and replacement therapy (KFRT) was reduced by 34% in those with advanced CKD who initiated treatment with an ACEI or ARB, however, neither ACEi nor ARB treatment initiation affected risk for death. The effect of ACEis or ARBs did not vary by age, estimated glomerular filtration rate (eGFR), albuminuria, or history of diabetes for the outcome of kidney failure or death; however, there may have been a signal that the effect was less pronounced in those with diabetes for the outcome of KFRT. According to the study authors, these findings suggest that initiation of treatment with an ACEi or ARB may be beneficial to patients with late-stage CKD.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Elaine Ku, MD, MAS, please contact Suzanne Leigh at suzanne.leigh@ucsf.edu.

----------------------------