Posted by ed_uk on September 23, 2005, at 16:33:12
From the Pharmaceutical Journal UK.......
New and old antipsychotics have similar efficacy
First and second generation antipsychotics are comparably effective but both associated with high rates of stopping therapy, according to research published in the New England Journal of Medicine this week (2005;353:1209).
Jeffrey Lieberman, department of psychiatry, Columbia University, New York, and colleagues conducted a randomised controlled trial involving 1,493 patients with schizophrenia. Patients received either the first generation antipsychotic perphenazine (similar to Haldol) or a second generation antipsychotic — Zyprexa, Seroquel or Risperdal for up to 18 months. Geodon was also included following its approval by the US Food and Drug Administration. The primary outcome measure was time to discontinuation of the drug for any reason. Patients’ symptoms were also evaluated.
Overall, 74 per cent of patients discontinued the study medication before 18 months. Discontinuation was highest among the Seroquel group (82 per cent) and lowest among the Zyprexa group (64 per cent).
Zyprexa was considered the most effective drug in terms of rates of stopping therapy — time to discontinuation for any cause was longer in the Zyprexa than the Seroquel (P<0.001) or Risperdal group (P=0.002). Time to discontinuation due to side effects was similar in all groups, however Zyprexa was associated with more stopping of therapy due to weight gain and increases in glycosylated haemoglobin, cholesterol and triglycerides. Results for the other second generation antipsychotics and perphenazine were similar in most respects, say the researchers.
An accompanying editorial (ibid, p1286) notes that Clozaril was omitted because it has already been observed to have superior efficacy. “It would thus seem reasonable to try Zyprexa and Clozaril in any patient with schizophrenia who has not had a full clinical remission of the illness, which includes the reversal of cognitive and psychosocial disabilities. However, it is also prudent to switch treatment from these drugs to one of the others if a metabolic syndrome is threatening the patient’s general health,” it says.
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thread:558590
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