People with schizophrenia are at considerably higher risk of cardiometabolic morbidity than the general population. Second-generation antipsychotic drugs contribute to that risk partly through their weight gain effects, exacerbating an already high burden of disease. While standard ‘as-randomized’ analyses of clinical trials provide valuable information, they ignore adherence patterns across treatment arms, confounding estimates of realized treatment exposure on outcome. We assess the effect of specific second-generation antipsychotics on weight gain, defined as at least a 7% increase in weight from randomization, using a Bayesian hierarchical model network meta-analysis with individual patient level data. Our data consisted of 14 randomized clinical trials contributing 5923 subjects (mean age = 39 [SD = 12]) assessing various combinations of olanzapine (n = 533), paliperidone (n = 3482), risperidone (n = 540), and placebo (n = 1368). The median time from randomization to dropout or trial completion was 6 weeks (range: 0–60 weeks). The unadjusted probability of weight gain in the placebo group was 4.8% across trials. For each 10 g chlorpromazine equivalent dose increase in olanzapine, the odds of weight gain increased by 5 (95% credible interval: 1.4, 5.3); the effect of risperidone (odds ratio = 1.6 [0.25, 9.1]) was estimated with considerable uncertainty but no different from paliperidone (odds ratio = 1.3 [1.2, 1.5]).

与一般人群相比，精神分裂症患者发生心脏代谢疾病的风险要高得多。第二代抗精神病药物部分地通过其体重增加效应而导致这种风险，加剧了本已很高的疾病负担。尽管标准的“随机化”临床试验分析提供了有价值的信息，但它们忽略了各个治疗方案之间的依从性模式，混淆了实际治疗效果对结果的估计。我们使用具有个别患者水平数据的贝叶斯分层模型网络元分析，评估特定的第二代抗精神病药对体重增加的影响，体重增加被定义为随机化导致体重增加至少7％。n  = 533），帕潘立酮（n  = 3482），利培酮（n  = 540）和安慰剂（n  = 1368）。从随机分组到辍学或试验完成的中值时间为6周（范围：0-60周）。在整个试验中，安慰剂组体重增加的未经调整的概率为4.8％。奥氮平每增加10克氯丙嗪当量剂量，体重增加几率增加5（95％可信区间：1.4、5.3）；估计利培酮的作用（比值= 1.6 [0.25，9.1]）具有相当大的不确定性，但与帕潘立酮（比值= 1.3 [1.2，1.5]）没有区别。