激光光凝联合玻璃体腔注射曲安奈德治疗视网膜分支静脉阻塞黄斑水肿的临床疗效观察

目的 观察激光光凝联合玻璃体腔注射曲安奈德治疗视网膜分支静脉阻塞黄斑水肿的疗效和安全性.方法 据荧光素眼底血管造影(FFA)对20例(22眼)视网膜分支静脉阻塞(BRVO)患者行黄斑区格栅样光凝后玻璃体腔注射曲安奈德0.1ml/(4mg),随访9个月,观察并再行荧光素眼底血管造影检查;OCT检查(干涉光断层扫描仪检查)...     

雷珠单抗对视网膜中央静脉阻塞继发黄斑水肿患者黄斑区视网膜血流参数的影响

目的 观察视网膜中央静脉阻塞(CRVO)继发黄斑水肿患者黄斑区视网膜血流参数以及观察雷珠单抗治疗前后黄斑区视网膜血流参数的变化。 方法 前瞻性对照研究。纳入2015年11月至2017年1月在襄阳市中心医院眼科就诊的CRVO继发黄斑水肿的患者33例为CRVO组,同时纳入健康人30例为对照组。所有CRVO继发黄斑水肿患者接受玻璃体腔内雷珠单抗注射治疗。用RTVue-100光学相干断层扫描血流成像技术3 mm×3 mm扫描模式测量研究对象黄斑区视网膜血管密度以及中央凹无血管区域(FAZ)面积。 结果 CRVO组的黄斑区视网膜浅层血管密度与深层血管密度分别为43.03%±5.11%以及47.00%±7.54%,对照组浅层以及深层视网膜血管密度分别为63.23%±5.50%以及61.43%±7.90%,两组之间均差异有统计学意义(P<0.001)。CRVO组FAZ面积为(0.49±0.08) mm²,对照组为(0.28±0.07) mm²,CRVO组FAZ面积明显小于对照组,均差异有统计学意义(P<0.001)。球内注射雷珠单抗后,CRVO组视网膜浅层与深层血管密度以及FAZ面积均未发生明显变化。 结论 相对于健康人,CRVO继发黄斑水肿的视网膜血管密度较低,FAZ面积偏大。CRVO继发黄斑水肿患者接受球内雷珠单抗治疗后,视网膜血管密度以及FAZ面积未见明显变化。     

Intravitreal bevacizumab and dexamethasone implant for treatment of chronic diabetic macular edema

Objective: To evaluate anatomical and functional outcomes of intraviteal bevacizumab (IVB) in patients with chronic diabetic macular edema (DME), and the effectivity and safety of dexamethasone implant in those unresponsive to regular IVB treatment. Methods: Thirty-five eyes of 35 patients (16 male and 19 female) with chronic DME (central foveal thickness (CFT) >?275?μm, duration >?6 months) received three injections of 2.5?mg IVB with six-week intervals. At 18 weeks, dexamethasone implant was applied to patients unresponsive to IVB. Main outcomes were the change in best corrected visual acuity (BCVA), CFT and ocular and systemic adverse effects for both drugs. The patients responsive to IVB were followed up for 36 weeks and those patients receiving dexamethasone implant were followed up for 24 weeks postoperatively. Results: At 18 weeks, the mean BCVA (0.68?±?0.40 logMAR, p?=?0.45) and CFT (453?±?169?μm, p?=?0.58) did not show any significant change compared to baseline (0.74?±?0.42 logMAR and 521?±?151?μm, respectively). In 20 patients (%57.1) responsive to IVB, the CFT was significantly improved from 12 to 36 weeks with the mean value of 295?±?42 μ (p?=?0.01). However, no significant difference was observed for BCVA during this period (p?=?0.17). Dexamethasone was implanted in 15 eyes (42.8%) unresponsive to IVB at 18 weeks. Statistically significant improvements were observed in BCVA (at postoperative 4 and 12 weeks) and CFT (at postoperative 4, 12 and 24 weeks). In addition, both parameters significantly worsened at 24 weeks compared to 12 weeks (p?<?0.001 and p?=?0.01, respectively). Conclusions: Patients with chronic DME should be followed in accordance with a fixed treatment protocol combining anti-VEGF and steroid treatments.     

玻璃体腔注射雷珠单抗联合筋膜囊注射曲安奈德治疗视网膜静脉阻塞继发黄斑水肿

目的 评价玻璃体腔注射雷珠单抗(ranibizumab)联合筋膜囊下注射曲安奈德(TA)治疗视网膜静脉阻塞(RVO)继发黄斑水肿(ME)的临床疗效。方法 经眼底荧光血管造影(FFA)及光学相干断层扫描(OCT)检查确诊为RVO合并黄斑水肿的患者30例,30眼。对比分析单次玻璃体腔注射雷珠单抗联合筋膜囊下注射TA治疗前后最佳矫正视力(BCVA)、OCT的变化。结果 治疗前与治疗后1周、1、3个月BCVA分别为(0.727±0.115)、(0.591±0.062)、(0.528±0.083)、(0.494±0.082);黄斑中心厚度(CMT)分别为(482.6±75.9)μm、(402.7±77.2)μm、(344.6±72.7)μm、(310.6±68.7)μm。治疗后1周、1、3个月BCVA显著提高,CMT显著降低,与治疗前相比差异均具有统计学意义(P<0.05);治疗后1、3个月分别与治疗后1周相比,BCVA显著提高,CMT显著降低,差异均具有统计学意义(P<0.05);治疗后3个月和1个月相比,BCVA提高,CMT降低,但差异无统计学意义(P>0.05)。结论 玻璃体腔注射雷珠单抗联合筋膜囊下注射TA可以在短期内减轻黄斑水肿、提高BCVA,为RVO继发黄斑水肿治疗提供了新的思路,但长期效果有待进一步观察。     

康柏西普玻璃体腔注射联合黄斑格栅样激光光凝治疗视网膜分支静脉阻塞性黄斑水肿 22例

目的评估康柏西普玻璃体腔注射联合黄斑格栅样激光光凝对视网膜分支静脉阻塞( BRVO)继发黄斑水肿病人的最佳矫正视力( BCVA)和黄斑中心视网膜厚度( CMT)的改善情况。方法选取 2015年 12月至 2017年 12月安徽省第二人民医院收治的 BRVO继发黄斑水肿病人 41例,分为观察组 22例,对照组 19例,观察组采用康柏西普玻璃体腔注射联合黄斑格栅样激光光凝治疗,对照组单纯采用康柏西普玻璃体腔注射治疗。两组在治疗前和治疗开始后 1,3,6和 12个月分别收集 BCVA和光学相干断层扫描记录的 CMT,观察组在第一次或随后的康柏西普注射后,在黄斑水肿( CMT≤350 um)减轻后 15 d立即进行黄斑格栅样激光光凝治疗。在随访期间,如果在光学相干断层扫描中观察到持续性或复发性黄斑水肿,则每隔 1个月再次采用康柏西普玻璃体腔注射。结果观察组和对照组康柏西普玻璃体腔平均注射次数分别为 2.8次和 3.2次,观察组的平均注射次数明显低于对照组( P＜0.05);与治疗前相比,治疗后 1、3、6和 12个月两组的 BCVA均明显提高( P＜0.05),但两组间治疗治疗前后效果差异无统计学意义( P＞0.05);与治疗前相比,治疗后 1、3、6和 12个月两组 CMT均明显下降( P＜0.05),并且观察组的治疗效果优于对照组( P＜0.05)。结论康柏西普玻璃体腔注射联合黄斑格栅样激光光凝可有效提高视网膜分支静脉阻塞性黄斑水肿病人的视力,减少康柏西普玻璃体腔注药次数,优于单纯康柏西普玻璃体腔注射治疗。     

曲安奈德玻璃体腔注射治疗视网膜分支静脉阻塞继发黄斑水肿

目的观察玻璃体腔曲安奈德注射(IVTA)治疗视网膜分支静脉阻塞(BRVO)继发的黄斑水肿的近期疗效和安全性。方法对22例(23眼)BRVO继发的严重黄斑水肿的患者,患眼IVTA4mg/1ml,观察治疗前和治疗后1d、3d、1周、1个月、3个月时视力、眼压、眼内炎症反应、晶体、眼底改变。结果 23眼中有20眼(86.9%)视力提高,3眼(13.1%)视力不变。logMAR视力治疗前为:0.75±0.48,治疗后1周、1个月、3个月时分别为:0.57±0.43;0.38±0.32;0.29±0.29。治疗前后比较差异有统计学意义(P<0.01)。结论 IVTA可以在短时间内有效地治疗BRVO继发的黄斑水肿。     

玻璃体腔注射康柏西普治疗糖尿病性和视网膜静脉阻塞性黄斑水肿的疗效对比观察

目的：对比研究糖尿病和视网膜静脉阻塞继发黄斑水肿患者玻璃体腔注射康柏西普治疗临床疗效差异。方法：选取自2016年3月-2017年10月收入某院行玻璃体腔注射康柏西普治疗糖尿病性黄斑水肿者21例/30只眼,视网膜静脉阻塞性黄斑水肿者35例/35只眼。回顾性对比观察这2组患者治疗后1个月、3个月及末次随诊时者最佳矫正视力（BCVA）和中央黄斑区视网膜厚度（CMT）及其变化,以及治疗有效率、黄斑水肿复发率、治疗病程和注药次数等,采用方差分析的方法对这些指标进行组间和组内统计学比较。结果：比较康柏西普玻璃体腔内注射治疗后1个月、3个月及末次随访时与治疗前基线的BCVA差值（ΔBCVA）和CMT差值（ΔCMT）,静脉阻塞组均高于糖尿病组并具有显著性（P<0.05）。静脉阻塞组和糖尿病组治疗有效率分别为100%和86.7%,复发率为14.3%和20.0%;静脉阻塞组和糖尿病组的患者治疗病程分别为（4.40±1.90）个月和（5.72±3.03）个月,注药次数为（2.51±0.74）次和（3.07±1.34）次,均具有显著性（P<0.05）。所有患者治疗随访过程中未见明显与药物、玻璃体腔注射相关的眼部和全身不良事件的发生。结论：玻璃体腔内注射康柏西普治疗视网膜静脉阻塞性和糖尿病性黄斑水肿均有较好疗效,但静脉阻塞患者其黄斑水肿消退和视力提升更为显著和迅速,而糖尿病患者治疗病程更长,需要更多次（3次以上甚至更多次）注药才能控制黄斑水肿的病情。     

玻璃体内注射雷珠单抗与曲安奈德治疗视网膜静脉阻塞继发黄斑囊样水肿的疗效比较

目的：比较玻璃体内注射雷珠单抗与曲安奈德治疗视网膜静脉阻塞（ retinal vein occlusion ,RVO）继发黄斑囊样水肿（ cystoidmacular edema ,CME）的疗效及安全性。方法97例RVO继发CME患者按治疗方法分为雷珠单抗组（n＝47）和曲安奈德组（n＝50）。雷珠单抗组给予玻璃体内注射雷珠单抗0．5 mg（0．05 ml）;曲安奈德组给予玻璃体内注射雷珠单抗4．0 mg（0．1 ml）。治疗后随访6个月,比较2组最佳矫正视力（best corrected visual acuity,BC－VA）、黄斑中心凹厚度（ central macular thickness ,CMT）、眼压及并发症发生率。结果2组治疗后各时间点BCVA均较治疗前显著提高（P＜0．05）,但2组间比较差异无统计学意义（P＞0．05）。2组治疗后各时间点CMT均较治疗前显著降低（P＜0．05）,但2组间比较差异无统计学意义（P＞0．05）。雷珠单抗组治疗后各时间点眼压与治疗前比较差异无统计学意义（ P＞0．05）;曲安奈德组治疗后各时间点眼压均较治疗前和雷珠单抗组显著提高（ P＜0．05）。曲安奈德组和雷珠单抗组眼压升高发生率比较,差异有统计学意义（P＜0．05）。结论玻璃体内注射雷珠单抗治疗RVO继发CME,可有效提高BCVA、降低CMT,其效果与曲安奈德相当,且安全性更高。     

Comparative efficacy and tolerability of pharmacological and somatic interventions in adult patients with treatment-resistant depression: a systematic review and network meta-analysis

Objective: Major depressive disorder (MDD) affects about 10–15% of the general population in a lifetime. A considerable number of patients fail to achieve full symptom remission despite adequate treatment and are considered treatment resistant (TRD). The current study compared the relative efficacy and tolerability of pharmacological and somatic TRD interventions by means of a Bayesian network meta-analysis.

Research design and methods: An electronic literature search of MEDLINE, MEDLINE In-Process, EMBASE, PsycInfo, EconLit and Cochrane Library databases for trials published between September 2003 and September 2014 was conducted. Key outcomes extracted were disease severity change from baseline, response and remission rates at various timepoints and discontinuation due to adverse events.

Results: Of the 3876 abstracts identified, 31 publications/randomised controlled trials (RCTs) were included in the analysis; 19 RCTs investigating 13 pharmacological interventions and 12 RCTs investigating electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS). The evidence synthesis investigating efficacy outcomes of TRD treatments demonstrated superior efficacy for ketamine compared to pharmacological and somatic interventions at 2 weeks after treatment initiation. At 4, 6 and 8 weeks, quetiapine augmentation (800?mg/day) and risperidone augmentation were found to be the first and second best treatments, respectively. Networks were small for response rate and remission rate outcomes at most timepoints. The most tolerable treatment was lamotrigine augmentation showing a comparable profile to placebo/sham.

Conclusions: This analysis revealed scarcity of long-term data on sustained remission that would allow a comparative long-term efficacy assessment. Key limitations of the analysis can be considered the search timeframe and the use of mapping formula for the depression scores.     

The cardiovascular effect of incretin-based therapies among type 2 diabetes: a systematic review and network meta-analysis

Objective: To evaluate the comparative cardiovascular safety of incretin-based therapies in patients with type 2 diabetes mellitus (T2DM).

Methods: Medline, Embase, the Cochrane Library and www.clinicaltrials.gov were searched for randomized controlled trials (RCTs) with duration≥12 weeks. Network meta-analysis was performed, followed by subgroup analysis and meta-regression. The Grading of Recommendations Assessment, Development and Evaluation system was used to assess the quality of evidence. The outcome of interest was a composite of cardiovascular death, myocardial infarction, stroke and heart failure. Odds ratio (OR) with 95% confidence interval (CI) was calculated as the measure of effect size.

Results: 281 RCTs (76.9% double-blinded) with 180,000 patients were included, comparing incretin-based therapies with other six classes of anti-diabetic drugs or placebo. A statistically significant reduction in the risk of cardiovascular events was found in favour of GLP-1RAs when compared with placebo (OR 0.89, 95%CI: 0.80–0.99) and sulfonylurea (OR 0.76, 95%CI: 0.59–0.99), whereas DPP-4 inhibitors showed a neutral effect compared with placebo (OR 0.92, 95%CI: 0.83–1.01).

Conclusions: Incretin-based therapies show similar cardiovascular risk in comparison with metformin, insulin, thiazolidinediones, alpha-glucosidase inhibitor and sodium-glucose co-transporter 2. GLP-1RA could decrease the risk compared with sulfonylurea or placebo, while DPP-4I appears to have neutral effect on cardiovascular risk.     

治疗视网膜分支静脉阻塞性黄斑水肿的临床疗效观察

目的评价曲安奈德玻璃体腔内注射治疗分支静脉阻塞性黄斑水肿的疗效及并发症。方法26例患者诊为分支静脉阻塞性黄斑水肿的共计26只眼,每只眼接受注射曲安奈德4mg（4mg/0.1ml）,检查注射前、后的视力、眼底、眼压、荧光造影及OCT。结果平均随访时间为5个月（1～8个月）,平均视力：注射前0.1,注射后1d：0.29;3d：0.55;1m：0.64;3m：0.59.与治疗前相比,有显著性差异。平均黄斑厚度：注射前（931.60±312.37）μm,注射后：1周：（297.05±84.23）μm;1个月：（221.53±51.67）μm;3个月：（185.54±49.16）μm,与治疗前比较有显著性差异。术后高眼压的发生率为34.62%,经药物或ALT治疗,眼压均恢复正常水平。无一例发生眼内炎。结论眼内注射曲安奈德可明显的改善视力及减轻因分支静脉阻塞而导致的黄斑水肿,但其疗效并非持久,且存在一些并发症。     

利巴韦林的安全性和有效性--Meta分析结果的系统综述

本文对利巴韦林有效性和安全性的meta分析进行了综述,在丙型肝炎患者中,与干扰素单独治疗相比,利巴韦林/干扰素联合治疗对丙型肝炎有更好的疗效,但增加了不良反应的发生率.利巴韦林治疗婴儿呼吸道合胞病毒感染的疗效尚无充分证据,需要进行更大的随机对照试验.     

Sedative drugs used for mechanically ventilated patients in intensive care units: a systematic review and network meta-analysis

Background: The effects of different sedative drugs on all-cause mortality rate, duration of ICU stay, and risk of delirium in mechanically ventilated ICU patients are unclear. This meta-analysis aimed to compare the effectiveness and safety of individual sedative drugs and drug combinations in mechanically ventilated ICU patients.

Materials and methods: Medline, Embase, Cochrane, EBSCOhost, and ISI Web of Science databases were searched for studies that assessed sedation in ICU mechanically ventilated patients. A Bayesian random-effects model was used to combine the direct comparisons and indirect evidence.

Results: Thirty-one randomized, controlled trials were included, which consisted of 4491 patients who received one of seven sedative drugs or a combination of drugs. There were no significant differences regarding the all-cause mortality rate. Compared to propofol, inhalation anesthetics (hazard ratio [HR] 0.121; 95% credible interval [CrI] -7.58 to 7.62), alpha agonists (HR 2.2; 95% CrI 0.776 to 5.22), propofol with benzodiazepines (HR 0.306; 95% CrI -6.97 to 7.65), ketamine with benzodiazepines (HR 6.57; 95% CrI -6.05 to 19.1) and placebo (HR 2.4; 95% CrI -5.37 to 10.3), benzodiazepines (HR 3.62; 95% CrI 0.834 to 6.2) may increase the duration of ICU stay. Compared to alpha agonists, propofol (HR 2.4; 95% CrI 0.304 to 21.1) and placebo (HR 6.12; 95% CrI 0.745 to 54.6), benzodiazepines (HR 2.59; 95% CrI 1.08 to 7.4) were associated with incremental risks of delirium.

Conclusion: Compared to propofol, benzodiazepines may increase the duration of ICU stay. Compared to alpha agonists, benzodiazepines were associated with an increased risk of delirium.     

The efficacy and safety of riluzole for neurodegenerative movement disorders: a systematic review with meta-analysis

Neurodegenerative movement disorders mainly include Parkinson’s disease, atypical parkinsonisms, Huntington disease, and hereditary ataxia. Riluzole is the only drug approved by the US Food and Drug Administration for amyotrophic lateral sclerosis. The neuroprotective effects of riluzole have been observed in experimental models of neurodegenerative movement disorders. In this paper, we aimed to systematically analyze the efficacy and safety of riluzole for patients with neurodegenerative movement disorder. We searched the electronic databases such as PubMed, EMBASE, CINAHL, Cochrane Library and China National Knowledge Infrastructure until June 2017 for the eligible randomized controlled trials, as well as the unpublished and ongoing trials. For continuous data, we calculated standardized mean differences with 95% confidence intervals if studies did not use the same scales to measure outcomes. For dichotomous data, we calculated risk differences if a trial reported no adverse events or dropouts. We pooled the results using a random-effects model. We included nine studies with 1320 patients with neurodegenerative movement disorders, which compared riluzole with placebo. No significant difference was found in the number of participants with adverse events but with motor improvement in hereditary ataxia. There were only two studies focusing on neuroprotective effect. Riluzole is well-tolerated in the patients with neurodegenerative movement disorders. Riluzole seems to be promising for patients with hereditary ataxia in symptomatic effect, which needs to be further confirmed by well-designed studies in the future. Moreover, it makes sense to design long-term study focusing on neuroprotective effect of riluzole in disease-modifying.     

A systematic review of the efficacy and safety outcomes of anti-VEGF agents used for treating neovascular age-related macular degeneration: comparison of ranibizumab and bevacizumab

Abstract

Objective:

To systematically review ocular and systemic events in treatment of wet age-related macular degeneration (AMD) with anti-vascular endothelial growth factor antibodies, ranibizumab and bevacizumab, and to provide a detailed perspective of their differences on clinical use, efficacy and safety.     

Comparative efficacy and tolerability of anti-epileptic drugs for refractory focal epilepsy: systematic review and network meta-analysis reveals the need for long term comparator trials

Aims

To evaluate the comparative efficacy (50% reduction in seizure frequency) and tolerability (premature withdrawal due to adverse events) of anti-epileptic drugs (AEDs) for refractory epilepsy.

Methods

We searched Cochrane Central Register of Controlled Trials (Cochrane Library 2009, issue 2) including Epilepsy Group''s specialized register, MEDLINE (1950 to March 2009), EMBASE (1980 to March 2009), and Current Contents Connect (1998 to March 2009) to conduct a systematic review of published studies, developed a treatment network and undertook a network meta-analysis.

Results

Forty-three eligible trials with 6346 patients and 12 interventions, including placebo, contributed to the analysis. Only three direct drug comparator trials were identified, the remaining 40 trials being placebo-controlled. Conventional random-effects meta-analysis indicated all drugs were superior in efficacy to placebo (overall odds ratio (OR] 3.78, 95% CI 3.14, 4.55) but did not permit firm distinction between drugs on the basis of the efficacy or tolerability. A Bayesian network meta-analysis prioritized oxcarbazepine, topiramate and pregabalin on the basis of short term efficacy. However, sodium valproate, levetiracetam, gabapentin and vigabatrin were prioritized on the basis of short-term efficacy and tolerability, with the caveat that vigabatrin is recognized as being associated with serious visual disturbance with chronic use.

Conclusion

Of the wide range of AEDs licensed for the treatment of refractory epilepsy, sodium valproate, levetiracetam and gabapentin demonstrated the best balance of efficacy and tolerability. Until regulators mandate greater use of active comparator trials with longer term follow-up, network meta-analysis provides the only available means to quantify these clinically important parameters.     

First-line treatment in the management of advanced renal cell carcinoma: systematic review and network meta-analysis

Objectives: To conduct a systematic review and network meta-analysis (NMA) to assess effectiveness of first-line treatments for advanced renal cell carcinoma (RCC).

Methods: Database searches were conducted to identify randomized controlled trials (RCTs) reporting results for eligible treatments. A fixed-effect Bayesian NMA was conducted to assess the relative effectiveness of treatments, with progression-free survival (PFS) reported as hazard ratios (HRs) and 95% credible intervals (CrIs).

Results: Eleven unique RCTs were suitable for inclusion in the NMA. In the base case, in terms of PFS, sunitinib was superior compared with bevacizumab + IFN-α (HR = 0.79, 95% CrI: 0.64 – 0.96), everolimus (HR = 0.70, 95% CrI: 0.56 – 0.87), sorafenib (HR = 0.56, 95% CrI: 0.40 – 0.77) and temsirolimus + bevacizumab (HR = 0.74, 95% CrI: 0.56 – 0.96). Although, the point values for the mean and median HRs were < 1.0, there was no significant difference in PFS between sunitinib and axitinib, pazopanib or tivozanib. Although sensitivity analyses impacted the results of the NMA, no treatment was significantly more efficacious than sunitinib.

Conclusion: Results from this analysis suggest that there is no treatment superior to the current benchmark treatment, sunitinib, in the management of advanced RCC in the first-line setting.     

Metformin for olanzapine-induced weight gain: a systematic review and meta-analysis

Olanzapine is an atypical antipsychotic that is useful in schizophrenia and bipolar affective disorder, but its use is associated with troublesome weight gain and metabolic syndrome. A variety of pharmacological agents has been studied in the efforts to reverse weight gain induced by olanzapine, but current evidence is insufficient to support any particular pharmacological approach. We conducted a systematic review and meta-analysis of randomized controlled trials of metformin for the treatment of olanzapine-induced weight gain. Systematic review of the literature revealed 12 studies that had assessed metformin for antipsychotic-induced weight gain. Of these, four studies (n= 105) met the review inclusion criteria and were included in the final analysis. Meta-analysis was performed to see the effect size of the treatment on body weight, waist circumference and body-mass index (BMI). Weighted mean difference (WMD) for body weight was 5.02 (95% CI 3.93, 6.10) kg lower with metformin as compared with placebo at 12 weeks. For waist circumference, the test for heterogeneity was significant (P= 0.00002, I²= 85.1%). Therefore, a random effects model was used to calculate WMD, which was 1.42 (95% CI 0.29, 3.13) cm lower with metformin as compared with placebo at 12 weeks. For BMI, WMD was 1.82 (95% CI 1.44, 2.19) kg m⁻² lower with metformin as compared with placebo at 12 weeks. Existing data suggest that short term modest weight loss is possible with metformin in patients with olanzapine-induced weight gain.