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: PANSS total change at about week 6, by sex
Effect: No sex difference (DoSMD 0.04, 95% CI −0.09 to 0.18); prolactin rise greater in women (0.83, 0.67–0.99)

This individual participant data meta-analysis drew raw trial data from the Vivli and YODA sharing platforms and restricted its main analyses to 18 fixed-dose trials: 7,062 adults with acute schizophrenia, 2,168 of them women, treated with haloperidol, olanzapine, paliperidone, risperidone or placebo.

There was no sex difference in effect on overall symptoms at about six weeks (difference in standardised mean difference 0.04, 95% CI −0.09 to 0.18). Dose-response curves were alike in women and men, both levelling off at 3–5 mg risperidone equivalents, and the network analysis showed no sex-specific ranking.

Two differences did appear. Antipsychotics reduced all-cause dropout more in women (ratio of odds ratios 0.74, 0.56 to 0.98; moderate credibility), and prolactin rose more in women (difference 0.83, 0.67 to 0.99; high credibility). Other tolerability outcomes did not clearly differ.

In practice, dose and drug choice need not change by sex for efficacy, but prolactin deserves more attention in women — asking about menstrual change, galactorrhoea and sexual side effects, and weighing it in drug choice. Only five drugs were studied, so this cannot be extended to others.

Choose antipsychotic dose on clinical response, not sex; the dose-response curve was the same in women and men.
Aim within 3–5 mg risperidone equivalents for acute schizophrenia; benefit levelled off there in both sexes.
Ask women on antipsychotics about menstrual change, galactorrhoea and sexual side effects at each review.
Weigh prolactin effects more heavily when choosing a drug for a woman of reproductive age.
Remember the data cover only haloperidol, olanzapine, paliperidone and risperidone.

Why it matters

It settles that efficacy data from mostly male trials apply to women, and moves the sex question to side effects.

The statistics, in plain English

A difference of 0.04 with an interval crossing zero means no measurable sex difference in symptom response. A ratio of odds ratios of 0.74 means the dropout benefit was about a quarter larger in women, but the upper limit of 0.98 is close to 1, which is why credibility was rated moderate. The prolactin difference is large and its interval is far from zero.