Patterns of Serum Prolactin Elevation Associated with Nine Second-Generation Antipsychotics in a Large Cohort of Patients with Schizophrenia

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Conflicts of Interest

Identified Weaknesses

Rating Explanation

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Paper Summary

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Prolactin and Antipsychotics: Some Raise It More Than Others

This real-world database study examined the association between nine second-generation antipsychotics and serum prolactin elevation in a large cohort of patients with schizophrenia. It found varying levels of risk for prolactin elevation with different medications, highlighting the need for individualized treatment strategies. Researchers also observed differences in medication usage across various age groups.

Possible Conflicts of Interest

None identified

Identified Weaknesses

Differences in medication patterns and dosages between youth and adults

The study acknowledges that medication patterns and dosages differ significantly between youth and adult patients. This difference makes direct comparison and interpretation of results challenging.

Model convergence issues due to insufficient sample sizes

The models used for certain drugs (aripiprazole, perospirone, paliperidone, and ziprasidone) failed to converge, likely due to limited sample sizes within specific age groups. This makes it difficult to draw reliable conclusions about those particular medications' effects.

Retrospective study design

The study was conducted retrospectively using electronic medical records, introducing potential biases related to data quality, completeness, and accuracy.

Potential for unmeasured confounders

Although the study considers some confounding factors, it may not fully account for all variables influencing prolactin levels (e.g., other medications, comorbidities). The study attempts to address this issue with its statistical models and analysis procedures.

Rating Explanation

This is a well-conducted retrospective study with a large sample size, examining a clinically relevant topic. Although there are inherent limitations due to its retrospective nature and potential confounders, the statistical methods employed are appropriate and the findings are valuable. A prospective study would strengthen the causal claims and assess the real-world implications of prolactin elevation. The model convergence issues due to low sample sizes in some strata are a minor weakness.

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