Risperidone and olanzapine versus another first generation antipsychotic in
patients with schizophrenia inadequately responsive to first generation
antipsychotics.
Author(s): Chen JJ, Chan HY, Chen CH, Gau SS, Hwu HG.
Affiliation(s): Department of General Psychiatry, Taoyuan Mental Hospital, Taoyuan, Taiwan.
Publication date & source: 2012, Pharmacopsychiatry. , 45(2):64-71
OBJECTIVE: This study compares the efficacy of risperidone and olanzapine to that
of first-generation antipsychotics (FGAs) in patients with schizophrenia, who
failed to show a response to initial trials of FGAs.
METHOD: This study was an 8-week treatment, randomized, rater-blind,
active-control study with 3 treatment arms. 48 patients, who showed inadequate
response to 1 FGA, were enrolled and randomized into risperidone, olanzapine, or
FGA (haloperidol or trifluoperazine) groups. They were blindly assessed with the
Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression
Scale-Severity, and the Extrapyramidal Symptom Rating Scale (ESRS) at baseline
and biweekly.
RESULTS: All 3 groups demonstrated a significant decrease in the PANSS total,
positive, and general scores from baseline to endpoint (p-values range from 0.003
to 0.021). There were no significant differences among the 3 groups in score
changes. The olanzapine group had significant score reductions than the
risperidone and FGAs groups in terms of the ESRS subjective total score and did
not experience a significant increase in the dose of anticholinergics. The FGA
group demonstrated that extrapyramidal syndrome (EPS) worsened under an increased
dosage of anti-EPS drugs. Olanzapine was associated with significant body weight
gain (2.69 ± 4.0 kg, p=0.026), but there were no significant group differences on
weight gain.
CONCLUSIONS: Haloperidol or trifluoperazine demonstrated similar efficacy as
risperidone or olanzapine for patients with schizophrenia who had failed their
first trial with a FGA. Related double-blind, fixed dose studies with a larger
sample size are needed to confirm the results of our study.
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