BACKGROUND: Antipsychotic treatments are effective in managing symptoms in patients with schizophrenia (SZ) or bipolar I disorder (BD-I); however, they are associated with various side effects, including weight gain and sexual dysfunction. This study assessed patients’ preferences for characteristics associated with oral antipsychotics. Further, this study explored potential tradeoffs that patients may make between efficacy and tolerability.
METHODS: A cross-sectional online survey was designed to collect preference data using a discrete choice experiment (DCE). The DCE consisted of a series of choices between pairs of hypothetical oral antipsychotic treatments based on 5 characteristics: treatment efficacy (ie, symptom improvement), weight gain over 6 months, sexual dysfunction, sedation, and akathisia. The DCE was pretested to ensure its comprehension and understanding among people with SZ (n=15) or BD-I (n=15). The final survey was administered to US adults with a self-reported diagnosis of SZ or BD-I.
RESULTS: A total of 144 respondents with SZ (mean age 41 years, 50% female, 69% White) and 152 respondents with BD-I (mean age 40 years, 70% female, 78% White) completed the survey. Most respondents with SZ or BD-I experienced side effects included in the DCE: weight gain (85%, 83%), sedation (82%, 93%), sexual dysfunction (75%, 76%), and akathisia (71%, 72%), respectively. Symptom improvement was the most important treatment attribute for respondents with SZ or BD-I. Weight gain and sexual dysfunction were the 2 side effects that respondents most wanted to avoid. Respondents preferred treatments associated with 0, 4, or 7 lb of weight gain over 6 months significantly more than treatments associated with 11 lb of weight gain. Respondents were willing to accept an increase in weight of 7 to 9 lb over 6 months for the smallest improvement in symptoms (1 incremental step of improvement in disease severity). For the largest improvement in symptom severity (2 incremental steps of improvement in disease severity), respondents were willing to accept weight gain of more than 11 lb over 6 months. With respect to sedation, respondents were willing to accept higher than 25% risk of sedation for any level of symptom improvement.
DISCUSSION: In this survey, treatment efficacy was the most important attribute of oral antipsychotics among the respondents with SZ or BD-I; weight gain and sexual dysfunction were the 2 side effects patients most wanted to avoid. Respondents with SZ or BD-I were willing to accept some weight gain as a side effect for better efficacy. As oral antipsychotics have different efficacy and tolerability profiles, it is important to understand the features that patients most value in a treatment and how they balance benefits and risks when choosing among options.
