Sex differences in antipsychotic efficacy and side effects in schizophrenia spectrum disorder: results from the BeSt InTro study
Abstract Current guidelines for patients with schizophrenia spectrum disease do not take sex differences into account, which may result in inappropriate sex-specific treatment. In the BeSt InTro study, a total of 144 patients (93 men and 51 women) with a schizophrenia spectrum diagnosis and ongoing...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Nature Portfolio
2021-08-01
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| Series: | npj Schizophrenia |
| Online Access: | https://doi.org/10.1038/s41537-021-00170-3 |
| _version_ | 1797427217249075200 |
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| author | Sanne Hoekstra Christoffer Bartz-Johannessen Igne Sinkeviciute Solveig K. Reitan Rune A. Kroken Else-Marie Løberg Tor K. Larsen Maria Rettenbacher Erik Johnsen Iris E. Sommer |
| author_facet | Sanne Hoekstra Christoffer Bartz-Johannessen Igne Sinkeviciute Solveig K. Reitan Rune A. Kroken Else-Marie Løberg Tor K. Larsen Maria Rettenbacher Erik Johnsen Iris E. Sommer |
| author_sort | Sanne Hoekstra |
| collection | DOAJ |
| description | Abstract Current guidelines for patients with schizophrenia spectrum disease do not take sex differences into account, which may result in inappropriate sex-specific treatment. In the BeSt InTro study, a total of 144 patients (93 men and 51 women) with a schizophrenia spectrum diagnosis and ongoing psychosis were included and randomized to amisulpride, aripiprazole, or olanzapine in flexible dose. This trial is registered with ClinicalTrials.gov (NCT01446328). Primary outcomes were sex differences in dose, dose-corrected serum levels, efficacy, and tolerability. Dosing was higher for men than for women in the aripiprazole group (p = 0.025) and, at trend level, in the olanzapine group (p = 0.056). Dose-corrected serum levels were 71.9% higher in women than in men for amisulpride (p = 0.019) and 55.8% higher in women than in men for aripiprazole (p = 0.049). In the amisulpride group, men had a faster decrease in psychotic symptoms than women (p = 0.003). Moreover, amisulpride was more effective than the other medications in men but not in women. Prolactin levels were higher in women than in men, especially for amisulpride (p < 0.001). Also, women had higher BMI increase on amisulpride compared to the two other antipsychotics (p < 0.001). We conclude that clinicians should be aware of the risks of overdosing in women, especially for amisulpride and aripiprazole. Amisulpride is highly effective in men, but in women, amisulpride showed more severe side effects and may thus not be the drug of first choice. Our study shows that sex differences should be taken into account in future studies on antipsychotics. Future research is warranted to evaluate these preliminary results. |
| first_indexed | 2024-03-09T08:42:00Z |
| format | Article |
| id | doaj.art-8f959b36fc4c4460b9ce17b156b517e2 |
| institution | Directory Open Access Journal |
| issn | 2334-265X |
| language | English |
| last_indexed | 2024-03-09T08:42:00Z |
| publishDate | 2021-08-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | npj Schizophrenia |
| spelling | doaj.art-8f959b36fc4c4460b9ce17b156b517e22023-12-02T16:37:32ZengNature Portfolionpj Schizophrenia2334-265X2021-08-01711710.1038/s41537-021-00170-3Sex differences in antipsychotic efficacy and side effects in schizophrenia spectrum disorder: results from the BeSt InTro studySanne Hoekstra0Christoffer Bartz-Johannessen1Igne Sinkeviciute2Solveig K. Reitan3Rune A. Kroken4Else-Marie Løberg5Tor K. Larsen6Maria Rettenbacher7Erik Johnsen8Iris E. Sommer9Department of Biomedical Sciences of Cells and Systems and Department of Psychiatry, Rijksuniversiteit Groningen (RUG), University Medical Center Groningen (UMCG)NORMENT - Norwegian Centre for Mental Disorders Research, Division of Psychiatry, Haukeland University HospitalNORMENT - Norwegian Centre for Mental Disorders Research, Division of Psychiatry, Haukeland University HospitalDepartment of Mental Health, St. Olavs HospitalNORMENT - Norwegian Centre for Mental Disorders Research, Division of Psychiatry, Haukeland University HospitalDepartment of Addiction Medicine, Division of Psychiatry, Haukeland University HospitalDepartment of Clinical Medicine, University of BergenDepartment of Psychiatry, Medical University of InnsbruckNORMENT - Norwegian Centre for Mental Disorders Research, Division of Psychiatry, Haukeland University HospitalDepartment of Biomedical Sciences of Cells and Systems and Department of Psychiatry, Rijksuniversiteit Groningen (RUG), University Medical Center Groningen (UMCG)Abstract Current guidelines for patients with schizophrenia spectrum disease do not take sex differences into account, which may result in inappropriate sex-specific treatment. In the BeSt InTro study, a total of 144 patients (93 men and 51 women) with a schizophrenia spectrum diagnosis and ongoing psychosis were included and randomized to amisulpride, aripiprazole, or olanzapine in flexible dose. This trial is registered with ClinicalTrials.gov (NCT01446328). Primary outcomes were sex differences in dose, dose-corrected serum levels, efficacy, and tolerability. Dosing was higher for men than for women in the aripiprazole group (p = 0.025) and, at trend level, in the olanzapine group (p = 0.056). Dose-corrected serum levels were 71.9% higher in women than in men for amisulpride (p = 0.019) and 55.8% higher in women than in men for aripiprazole (p = 0.049). In the amisulpride group, men had a faster decrease in psychotic symptoms than women (p = 0.003). Moreover, amisulpride was more effective than the other medications in men but not in women. Prolactin levels were higher in women than in men, especially for amisulpride (p < 0.001). Also, women had higher BMI increase on amisulpride compared to the two other antipsychotics (p < 0.001). We conclude that clinicians should be aware of the risks of overdosing in women, especially for amisulpride and aripiprazole. Amisulpride is highly effective in men, but in women, amisulpride showed more severe side effects and may thus not be the drug of first choice. Our study shows that sex differences should be taken into account in future studies on antipsychotics. Future research is warranted to evaluate these preliminary results.https://doi.org/10.1038/s41537-021-00170-3 |
| spellingShingle | Sanne Hoekstra Christoffer Bartz-Johannessen Igne Sinkeviciute Solveig K. Reitan Rune A. Kroken Else-Marie Løberg Tor K. Larsen Maria Rettenbacher Erik Johnsen Iris E. Sommer Sex differences in antipsychotic efficacy and side effects in schizophrenia spectrum disorder: results from the BeSt InTro study npj Schizophrenia |
| title | Sex differences in antipsychotic efficacy and side effects in schizophrenia spectrum disorder: results from the BeSt InTro study |
| title_full | Sex differences in antipsychotic efficacy and side effects in schizophrenia spectrum disorder: results from the BeSt InTro study |
| title_fullStr | Sex differences in antipsychotic efficacy and side effects in schizophrenia spectrum disorder: results from the BeSt InTro study |
| title_full_unstemmed | Sex differences in antipsychotic efficacy and side effects in schizophrenia spectrum disorder: results from the BeSt InTro study |
| title_short | Sex differences in antipsychotic efficacy and side effects in schizophrenia spectrum disorder: results from the BeSt InTro study |
| title_sort | sex differences in antipsychotic efficacy and side effects in schizophrenia spectrum disorder results from the best intro study |
| url | https://doi.org/10.1038/s41537-021-00170-3 |
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