Patient Preferences and Concessions to the Side Effects of Oral Antipsychotics

While schizophrenia or bipolar I disorder are often managed effectively with antipsychotic treatments, those treatments are associated with side effects, including weight gain and sexual dysfunction. A survey study, presented by Marco Boeri at the American Psychiatric Association 2023 Annual Meeting, explored patient preferences and behaviors related to different antipsychotics characteristics, efficacy, and tolerability.

According to survey responses, the researchers identified that treatment efficacy was the most important characteristic for oral antipsychotics. Additionally, while patients most wanted to avoid weight gain and sexual dysfunction, they were willing to accept some weight gain as a tradeoff for better efficacy.

These preferences were based on 144 patients with a self-reported diagnoses of schizophrenia (mean age, 41 years; 50% female; 69% White) and 152 with bipolar I disorder (mean age, 40 years; 70% female; 78% White).

Participants completed an online cross-sectional survey with a discrete choice experiment involving a series of choices between two hypothetical oral antipsychotics with varying treatment efficacy, weight gain over six months, sexual dysfunction, sedation, and akathisia.

The study reported most survey respondents had experienced side effects featured in the survey; specifically, 85% and 83% of patients with schizophrenia or bipolar I disorder, respectively, experienced weight gain; 82% and 93% experienced sedation; 75% and 76% experienced sexual dysfunction; and 71% and 72% experienced akathisia.

Participants identified treatment efficacy, represented by incremental steps of improvement in disease severity, as the most important attribute of oral antipsychotics. Additionally, patients significantly preferred choices with zero, four, or seven pounds of weight gain over six months versus those with 11 pounds of weight gain.

However, patients were willing to accept a weight gain of seven to nine pounds for one incremental improvement in symptom severity, or a weight gain of more than 11 pounds for two incremental steps of improvement. Likewise, researchers noted patients were willing to accept a >25% risk of sedation for any degree of symptom improvement.

Overall, Boeri and colleagues identified preferences and tradeoffs related to the side effects of oral antipsychotic medication in patients with schizophrenia or bipolar I disorder. “As oral antipsychotics have different efficacy and tolerability profiles, it is important to understand the features that patients value in a treatment and how they balance benefits and risks when choosing among treatments,” they suggested.