New Drugs No Better Than Older Ones for Schizophrenia

FRIDAY, March 28 (HealthDay News) -- 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%26#39;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%26#39;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%26#39;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%26#39;t know who%26#39;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%26#39; 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, %26#39;I
want my patients on newer drugs as soon as possible,%26#39; " 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%26#39;s the
standard for evaluating drugs," Rosenheck said.

More information

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