New Drugs No Better Than Older Ones for Schizophrenia

FRIDAY March 28, 2008 -- Newer, so-called second-generation antipsychotics are no better than the older drug haloperidol in treating a first episode of schizophrenia, a new study finds.

However, it appears that more patients prefer the newer drugs and are more likely to continue using them than haloperidol, the study authors said.

"When we compared newer drugs to older drugs, we found that patients stay longer on the new drugs," said lead researcher Dr. Rene Kahn, a professor of psychiatry at the University Medical Centre Utrecht in the Netherlands.

Earlier studies had found 70 percent of schizophrenia patients stopped taking the older antipsychotics. In the new study, 70 percent of patients kept with the newer drugs, Khan noted.

"The biggest reason that they stayed longer was that doctors perceived the newer drugs as more efficacious," Khan said. "That's the way real life is -- real life is that patients and doctors perceive their medication to have a certain efficacy."

But, if you look at improvement in symptoms and the number of times patients were hospitalized after the first treatment, then the drugs did not differ, Khan said.

The findings are published in the March 29 issue of The Lancet.

Kahn's team randomly assigned 498 patients to haloperidol, or higher-dose second-generation drugs that included amisulpride, olanzapine, quetiapine and ziprasidone.

Over the following year, 63 patients discontinued haloperidol, compared with 32 who stopped using amisulpride, 30 who stopped using olanzapine, 51 who quit quetiapine and 31 who stopped taking ziprasidone, the researchers found.

However, regardless of which medication the patients were taking, 60 percent saw a reduction in their symptoms, the researchers found. And, when the researchers looked at gender, and side effects such as suicidal behavior and substance abuse, they didn't find any significant difference among the drugs.

The hopeful sign is that patients taking the newer drugs stayed on them longer, Khan said.

"Overall, we should be encouraged that if we give the patients the right drug, that in 60 to 70 percent of the cases, they still stay on the medication," Khan said. "We should not be so pessimistic, as earlier studies suggested, that we cannot treat schizophrenia because only 30 percent of the patients stayed on the drug."

Dr. Robert A Rosenheck, a professor of psychiatry at Yale University School of Medicine and author of an accompanying editorial in the journal, said the only way to test whether patients prefer the newer drugs to the older ones is to have an objective trial in which patients and doctors don't know who's getting which drug.

"In terms of the main outcome of how long patients stayed on their drugs, the study showed a benefit for the newer drugs," he said. But, since the doctors knew which drugs were being given, the study results likely reflected the doctors' opinions of the drugs, he added.

The study began in 2002, Rosenheck noted, when there was a lot of enthusiasm for these new drugs. "The assumption of many doctors was, 'I want my patients on newer drugs as soon as possible,' " he said.

"The only way you get an objective assessment is by doing a study in which you can be sure neither the patient nor the physician knows which drug it is. So, they are just judging by the clinical outcomes. That's the standard for evaluating drugs," Rosenheck said.

More information

For more on schizophrenia, visit the U.S. National Institute of Mental Health.

Posted: March 2008


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