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...

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Autores principales:	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
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Psychiatry RC435-571
Acceso en línea:	https://doaj.org/article/8f959b36fc4c4460b9ce17b156b517e2
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spelling	oai:doaj.org-article:8f959b36fc4c4460b9ce17b156b517e22021-12-02T15:10:39ZSex differences in antipsychotic efficacy and side effects in schizophrenia spectrum disorder: results from the BeSt InTro study10.1038/s41537-021-00170-32334-265Xhttps://doaj.org/article/8f959b36fc4c4460b9ce17b156b517e22021-08-01T00:00:00Zhttps://doi.org/10.1038/s41537-021-00170-3https://doaj.org/toc/2334-265XAbstract 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.Sanne HoekstraChristoffer Bartz-JohannessenIgne SinkeviciuteSolveig K. ReitanRune A. KrokenElse-Marie LøbergTor K. LarsenMaria RettenbacherErik JohnsenIris E. SommerNature PortfolioarticlePsychiatryRC435-571ENnpj Schizophrenia, Vol 7, Iss 1, Pp 1-7 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Psychiatry RC435-571
spellingShingle	Psychiatry RC435-571 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
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.
format	article
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
title	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_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_sort	sex differences in antipsychotic efficacy and side effects in schizophrenia spectrum disorder: results from the best intro study
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/8f959b36fc4c4460b9ce17b156b517e2
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Sex differences in antipsychotic efficacy and side effects in schizophrenia spectrum disorder: results from the BeSt InTro study

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