Observed Sex Differences in Cardiometabolic Indices in Patients on Antipsychotics: Secondary Analyses of a 12-Month Multicenter, Randomized, Controlled Trial

Mark E. Schneiderhan, PharmD^a,* ; Xuan Li, PhD^b

Prim Care Companion CNS Disord 2021;23(2):19m02493

ABSTRACT

Objective: To define sex differences in cardiometabolic indice changes over 12 months in patients on antipsychotics and to describe treatment complexity, interventions, and patient satisfaction of pharmacist comprehensive medication management (CMM) services.

Methods: Secondary analyses of time effect–associated sex differences in cardiometabolic indices within and between study groups were done at baseline and 12 months. Each group consisted of 60 subjects who received full pharmacist CMM services (PCS) and 60 subjects who received either modified or no CMM services (NCS). Pharmacist CMM services are a team-based practice of providing direct patient care.

Results: Significant sex differences in mean change score were observed from baseline to 12 months in the combined PCS and NCS subjects. Compared to men, women had greater body weight (P = .003) and waist measurement (P = .02) reductions and increased serum level of high-density lipoproteins (P < .001). In contrast, men had greater systolic (P < .001) and diastolic (P = .005) blood pressure levels, more hypertension diagnoses (P = .01), and less dyslipidemia diagnoses (P = .001) compared to women at 12 months. Significant sex differences were observed in combined PCS and NCS groups for glycated hemoglobin (HgbA_1c) (women: −0.33%, P = .02) and low-density lipoprotein (men: −21.63 mg/dL, P = .04) at 12 months. In PCS women, a significant (P = .02) reduction in mean HgbA_1cpercentages (−0.46%) compared to PCS men (0.28%) was observed at 12 months. A higher percentage (62%, n = 28/45) of PCS women compared to PCS men (38%, n = 17/45) at 12 months continued to receive CMM services. Satisfaction survey results positively favored CMM services; however, the response rate was only 25% (n = 18/72).

Conclusions: Women on antipsychotics appear more likely to keep follow-up visits, return satisfaction surveys, reduce abdominal weight, and improve both HgbA_1c percentages and high-density lipid levels compared to men over 12 months. Women were satisfied overall with CMM services. Recognition of sex differences can promote a more personalized patient-centered care approach among patients prescribed antipsychotics.

Trial registration: ClinicalTrials.gov identifier: NCT02029989

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