Background Adjunctive metformin is the most well-studied intervention in the pharmacological management of antipsychotic-induced weight gain (AIWG). Although a relatively unaddressed area, among guidelines recommending consideration of metformin, prescribing information that would facilitate its applied use by clinicians, for example, provision of a dose titration schedule is absent. Moreover, recommendations differ regarding metformin’s place in the hierarchy of management options. Both represent significant barriers to the applied, evidence-based use of metformin for this indication. Objective To produce a guideline solely dedicated to the optimised use of metformin in AIWG management, using internationally endorsed guideline methodology. Methods A list of guideline key health questions (KHQs) was produced. It was agreed that individual recommendations would be ‘adopted or adapted’ from current guidelines and/or developed de novo, in the case of unanswered questions. A systematic literature review (2008–2020) was undertaken to identify published guidelines and supporting (or more recent) research evidence. Quality appraisal was undertaken using the Appraisal of Guidelines Research and Evaluation II tool, A Measurement Tool to Assess Systematic Reviews (AMSTAR) assessment,and the Cochrane Risk of Bias 2 tool, where appropriate. Assessment of evidence certainty and recommendation development was undertaken using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Findings We confirmed that no published guideline—of appropriate quality, solely dedicated to the use of metformin to manage AIWG was available. Recommendations located within other guidelines inadequately addressed our KHQs. Conclusion All 11 recommendations and 7 supporting good practice developed here were formulated de novo. Clinical implications These recommendations build on the number and quality of recommendations in this area, and facilitate the optimised use of metformin when managing AIWG. Data sharing not applicable as no datasets generated and/or analysed for this study.

中文翻译：

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二甲双胍治疗成人精神病患者抗精神病药引起的体重增加：使用 GRADE 方法制定第一个循证指南

背景 辅助二甲双胍是抗精神病药引起的体重增加 (AIWG) 药物治疗中研究最充分的干预措施。尽管这是一个相对未解决的领域，但在建议考虑使用二甲双胍的指南中，没有提供有助于临床医生应用二甲双胍的处方信息，例如剂量滴定表的规定。此外，关于二甲双胍在管理方案层次结构中的地位，建议也有所不同。两者都对二甲双胍在该适应症中的应用、循证使用构成了重大障碍。目标 使用国际认可的指南方法，制定专门针对 AIWG 管理中二甲双胍优化使用的指南。方法 制定了一份指南关键健康问题 (KHQ) 清单。会议同意，如果问题未得到解答，则将根据现行指南“采用或改编”个别建议和/或重新制定建议。我们进行了系统的文献综述（2008-2020），以确定已发表的指南和支持（或更新的）研究证据。在适当的情况下，使用指南研究和评估 II 评估工具、评估系统评价的测量工具 (AMSTAR) 评估以及 Cochrane 偏差风险 2 工具进行质量评估。使用建议评估、制定和评价分级 (GRADE) 方法对证据确定性和建议制定进行评估。结果 我们确认，目前还没有发布的、质量适当、专门针对使用二甲双胍来管理 AIWG 的指南。其他指南中的建议没有充分解决我们的 KHQ 问题。结论 这里制定的所有 11 项建议和 7 项支持性良好实践都是从头制定的。临床意义 这些建议建立在该领域建议的数量和质量的基础上，有助于在管理 AIWG 时优化二甲双胍的使用。数据共享不适用，因为本研究没有生成和/或分析数据集。