Influência de antipsicóticos de segunda geração na composição da microbiota intestinal

Abstract

Introduction: Second generation antipsychotics (SGA) are commonly prescribed as first-line treatment for psychotic disorders. However, they can induce weight gain and metabolic disturbances. Advances in molecular biology techniques enabled a better understand of the gut microbiota (GM), enabling the study of the interaction between SGA and GM, which has been suggested as a potential contributing factor to side effects of SGA. Therefore, considering also the prospect of some future prophylactic intervention, it is interesting to investigate this association. Objective: Conduct a systematic review of the literature to answer the P.I.C.O question (Patient, Intervention, Comparison groups, Outcomes): In patients with schizophrenia or other psychotic disorders, the use of SGA is associated with changes the GM composition? Methods: We searched for studies in the following databases: PubMed, PsycINFO, Web of Science, SCOPUS, Cochrane, LILLACS/BVS, Google Scholar, OpenGrey, OpenThesis, and clinicaltrials.gov. There were no restrictions on the design of study or publication date. Only studies in humans were considered, regardless of age, gender or setting. Two assessors carried out, independently, the search, study selection and data analysis. Results: Two studies fulfilled the eligibility criteria. They were small observational studies, with a high probability of bias and with several methodological differences that precluded meta-analysis of data. One of them assessed 18 male children, in a cross-sectional design, evidencing an increase in alpha diversity (Shannon index) of GM (5.9 x 5.2; p<0.05) and a decrease in the Bacteroidetes: Firmicutes ratio (0.20 x 1.24; p<0.05) after chronic exposure to risperidone. It also had a longitudinal arm with a 10 month follow up of 5 boys starting on risperidone, also showing a decrease in Bacteroidetes: Firmicutes ratio. The other paper showed results of a cross sectional evaluation of 117 adults diagnosed with bipolar disorder, associating the use of SGA to a decrease in alpha diversity (Simpson index) significant only in female subjects (P=0.015), and an increase in Lachnospiraceae genus (p=0,001). It also identified a preferentially abundance of Akkermansia (P=0.03) in the group that was not treated with SGA.