Comparative effects of prescription medications on body weight
- Patient-Centered Outcomes Research Institute (PCORI)
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Jason Block, MD, MPH
Project Summary
The widespread adoption of electronic health records has provided opportunities to conduct pragmatic research in real-world settings. The National Patient-Centered Clinical Research Network (PCORnet) is a large network of nearly 70 healthcare systems across the US, with data that is available from 2009. It facilitates multi-institutional research by use of a Common Data Model (CDM), in which all systems structure data in a similar format, facilitating interoperability. Since 2015, DPM has been led two projects that have utilized data from PCORnet to explore the comparative effects of prescription medications on body weight; these projects have been led or co-led by DPM investigators with a wide array of collaborators across healthcare systems and including patients and other stakeholders.
Funded by the Patient-Centered Outcomes Research Institute (PCORI), Dr. Block and colleagues examined the relationship between antibiotic use in early childhood on weight outcomes in the "Antibiotics and Childhood Growth Study," This study included nearly 700,000 children receiving care in 36 healthcare institutions across the US. The second project was developed and informed by feedback from stakeholders from the antibiotics study and is nearing completion. In this study, "Medications and Weight Gain in PCORnet: The MedWeight Study," a team at DPM, led by Dr. Block is examining prescription medication-induced weight gain in 15 healthcare institutions in PCORnet, using data on over 4 million children and adults. The classes of medications included are antidepressants, antihypertensives, anti-seizure medications, diabetes medications, and antipsychotics. Related work in PCORnet includes a grant in 15 PCORnet sites to investigate the relationship between COVID-19 infection and the natural history of diabetes, participation in the NIH-funded RECOVER initiative to explore post-acute sequelae of COVID-19, and collaboration on two pragmatic weight loss intervention trials within a large healthcare system.
Project Details
In the Antibiotics and Childhood Growth Study, the team found that antibiotic use in early childhood was associated with a small increase in weight in later childhood; more antibiotic use was associated with increasingly higher weight. However, the amount of weight increase was not deemed to be clinically meaningful, suggesting that antibiotics may not have a major role in weight gain in pediatric populations.
The MedWeight Study is ongoing. In the first published paper on the core outcomes of this study, the team found that antidepressants were associated with differential weight gain over time. Most weight change was rather limited, with slight differences among individuals medications. For example, use of bupropion led to decreased weight change over time (-0.22 kg compared to sertraline at 6 months). Among the SSRI and SNRI classes of medications, sertraline and fluoxetine had among the lowest weight change over time.