Hoekstra, Sanne (2020) Amisulpride is an excellent antipsychotic for male but not for female patients Results from the Best Intro Study. thesis, Medicine.
Full text available on request.Abstract
Background Similar antipsychotic pharmacotherapy for male and female patients may not be the best strategy, but currently most guidelines for schizophrenia do not take sex differences into account. Existing literature on efficacy and side-effects of different antipsychotic drugs in patients with schizophrenia spectrum disorders (SSD) is inconsistent and therefore more research is justified. Methods This naturalistic, randomized, rater-blind study with a 1 year follow-up was completed in 4 centers in Norway and Austria. Patients aged ≥ 18 with a diagnosis within the SSD (ICD-10) and symptoms of ongoing psychosis were randomized to amisulpride, aripiprazole or olanzapine in flexible dose. Outcome measurements were sex differences in serum blood levels, efficacy and tolerability, all measured by per protocol analyses. Data were analyzed with t-tests, linear mixed models and ANOVA. Findings 144 patients were included in the study; 52 used amisulpride (25 men and 27 women), 51 used aripiprazole (39 men and 12 women) and 41 used olanzapine (29 men and 12 women). Men in the aripiprazole group received higher doses than women (p=0.025). Serum blood levels corrected for dose were higher in women than in men for amisulpride (p=0.019) and aripiprazole (p=0.049), but not for olanzapine. A steeper decrease in psychotic symptoms was observed in men than women in the amisulpride group (p=0.003). In men, amisulpride was more effective than the other medications, but this was not the case in women. Most side-effects were mild for both men and women, apart from the prolactin level, which was significantly higher in women, especially for amisulpride (p<0.001). Interpretation Clinicians should be aware of the risks of overdosing in women, especially for amisulpride and aripiprazole. Amisulpride should be the antipsychotic of first choice in men, based on superior efficacy, but not in women, given the associated large increase in prolactin levels.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Prof. Dr. Sommer, I.E.C. and Prof. Dr. Johnsen, E. and Bartz-Johannessen, C. and Dr. Sinkeviciute, I. |
| Faculty: | Medical Sciences |
| Date Deposited: | 16 Oct 2023 13:00 |
| Last Modified: | 16 Oct 2023 13:00 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3707 |
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