Design: Individual participant data pairwise, dose-response and network meta-analyses
Population: 7,062 adults with acute schizophrenia in 18 fixed-dose trials (2,168 women)
Primary outcome: Change in PANSS total score at about 6 weeks
Effect: No sex difference in efficacy (DoSMD 0.04, 95% CI −0.09 to 0.18); larger prolactin rise in women (DoSMD 0.83, 0.67 to 0.99)

An individual participant data meta-analysis in The Lancet Psychiatry (30 September 2026) pooled 18 fixed-dose trials of acute schizophrenia from the Vivli and YODA data-sharing platforms: 7,062 adults, 2,168 of them women, on haloperidol, olanzapine, paliperidone, risperidone or placebo.

There was no sex difference in the effect on overall symptoms (difference in standardised mean difference 0.04, 95% CI −0.09 to 0.18). Dose-response curves were the same for women and men, flattening at about 3 to 5 mg of risperidone equivalents. Women had a larger drop in all-cause dropout with active drug (ratio of odds ratios 0.74) and a clearly larger rise in prolactin (difference 0.83, rated high credibility). Other side-effects showed no clear difference.

The practical message is reassuring and specific. Dose by response, not by sex. Expect and ask about prolactin effects in women, particularly on risperidone and paliperidone, which dominate these trials.

Use the same dose targets for women and men; benefit plateaued at about 3 to 5 mg risperidone equivalents in both.
Ask women on antipsychotics about menstrual change, galactorrhoea and sexual side-effects at each review.
Check prolactin when symptoms suggest it, and consider a prolactin-sparing option if it is high and troublesome.
Remember that women made up under a third of trial participants, so rarer sex-specific effects may still be missed.

Why it matters

It settles a long-running question on efficacy and points the sex difference at tolerability, where clinicians can act on it.

The statistics, in plain English

A difference in standardised mean difference of 0.04 with an interval crossing zero means women and men improved by about the same amount. A ratio of odds ratios of 0.74 means the drug's effect on dropout was about a quarter stronger in women, but the interval reaches 0.98, close to no difference. The prolactin difference is large and precise, which is why it was rated high credibility.