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Antipsychotics: Newer Doesn't Necessarily Mean Better in First-Episode Schizophrenia
Costly second-generation antipsychotics are no more effective than haloperidol in treating first-episode schizophrenia, according to an industry-sponsored study in Lancet.
Researchers randomized nearly 500 patients with first-episode schizophrenia, schizophreniform disorder, or schizoaffective disorder to open-label treatment either with low-dose haloperidol or with a second-generation antipsychotic (amisulpride, olanzapine, quetiapine, or ziprasidone). After 1 year, treatment had been discontinued more frequently among haloperidol recipients (72%) than among those on second-generation drugs (ranging from 33% to 53%). Reasons for discontinuation included a drug's insufficient efficacy, its side effects, or the patient's nonadherence.
Symptom reductions and hospitalization rates, however, were similar across all drugs.
The authors conclude that despite the high continuation rates across the newer drugs, "it cannot be concluded" that they are more efficacious than haloperidol. A commentator agrees, noting the problems caused by the trial's unblinded design — perhaps including "provider bias."
LINK(S):
Lancet article (Free abstract; full text requires subscription)
Lancet comment (Subscription required)
Published in Physician's First Watch March 28, 2008