Sex Differences Between Female and Male Individuals in Antipsychotic Efficacy and Adverse Effects in the Treatment of Schizophrenia.

IF 7.4 2区 医学 Q1 CLINICAL NEUROLOGY CNS drugs Pub Date : 2024-07-01 Epub Date: 2024-05-07 DOI:10.1007/s40263-024-01089-w
Megan Galbally, Karen Wynter, Dan Siskind, Christoph U Correll, Korinne Northwood, Susanna Every-Palmer
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Abstract

Background and objective: Antipsychotics are core treatments for people living with psychotic disorders. Understanding individualised factors that influence both efficacy and adverse responses will improve outcomes. The objective of this study was to examine sex differences in antipsychotic-related efficacy and tolerability.

Methods: This was a secondary analysis of data from phase 1 and 1a of Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE); participants with schizophrenia were randomly assigned to double-blinded treatment with oral olanzapine, quetiapine, risperidone, ziprasidone or perphenazine. Measures included Positive and Negative Syndrome Scale (PANSS), Clinical Global Impressions (CGI) scale and Calgary Depression Rating Scale, as well as self-reported side effects, medication compliance, dosage, weight measurements and various blood parameters.

Results: There were 1460 participants including 380 female and 1080 male individuals. Very few differences existed between male and female participants in response, adverse reactions, compliance or antipsychotic dosage. However, significantly more female participants than male participants reported constipation (28% vs 16%), dry mouth (50% vs 38%), gynecomastia/galactorrhea (11% vs 3%), incontinence/nocturia (16% vs 8%) and self reported weight gain (37% vs 24%) [all p < 0.001]. Within the risperidone treatment group, there was a significantly greater increase in prolactin levels (p < 0.001) among female participants (n = 61) than male participants (n = 159). No overall differences in clinician-rated measures, weight gain or other laboratory indicators were found.

Conclusions: While overall sex differences were limited across efficacy and tolerability for antipsychotic treatment, there were some specific findings with risperidone. Further examination of sex differences within antipsychotic trials will be important to improve efficacy and reduce adverse responses across as well as individualising care for people with schizophrenia.

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在治疗精神分裂症的抗精神病药疗效和不良反应方面,女性和男性的性别差异。
背景和目的:抗精神病药物是治疗精神病患者的核心药物。了解影响疗效和不良反应的个体化因素将有助于改善治疗效果。本研究旨在探讨抗精神病药物相关疗效和耐受性方面的性别差异:这是对临床抗精神病药物干预效果试验(CATIE)第1期和第1a期数据的二次分析;精神分裂症患者被随机分配接受口服奥氮平、喹硫平、利培酮、齐拉西酮或奋乃静的双盲治疗。测量指标包括阳性和阴性综合量表(PANSS)、临床总体印象量表(CGI)和卡尔加里抑郁量表,以及自我报告的副作用、服药依从性、剂量、体重测量和各种血液参数:共有 1460 名参与者,包括 380 名女性和 1080 名男性。男性和女性参与者在反应、不良反应、依从性或抗精神病药物剂量方面几乎没有差异。然而,报告便秘(28% 对 16%)、口干(50% 对 38%)、妇科炎症/乳腺增生(11% 对 3%)、尿失禁/夜尿(16% 对 8%)和自我报告体重增加(37% 对 24%)的女性参与者明显多于男性参与者[均为 p 结论:虽然抗精神病药物治疗的疗效和耐受性方面的性别差异总体有限,但利培酮有一些特殊的发现。进一步研究抗精神病药物试验中的性别差异对于提高疗效、减少不良反应以及为精神分裂症患者提供个体化治疗非常重要。
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来源期刊
CNS drugs
CNS drugs 医学-精神病学
CiteScore
12.00
自引率
3.30%
发文量
82
审稿时长
6-12 weeks
期刊介绍: CNS Drugs promotes rational pharmacotherapy within the disciplines of clinical psychiatry and neurology. The Journal includes: - Overviews of contentious or emerging issues. - Comprehensive narrative reviews that provide an authoritative source of information on pharmacological approaches to managing neurological and psychiatric illnesses. - Systematic reviews that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by the PRISMA statement. - Adis Drug Reviews of the properties and place in therapy of both newer and established drugs in neurology and psychiatry. - Original research articles reporting the results of well-designed studies with a strong link to clinical practice, such as clinical pharmacodynamic and pharmacokinetic studies, clinical trials, meta-analyses, outcomes research, and pharmacoeconomic and pharmacoepidemiological studies. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in CNS Drugs may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.
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