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Effectiveness of antipsychotics in first-episode: second-generation no better than first-generation drugs for schizophrenia


Second-generation antipsychotic drugs are not necessarily better than the first-generation drug Haloperidol ( Haldol ) at treating a first episode of schizophrenia.

Second-generation drugs, introduced over a decade ago, are purported to be more effective and less likely to induce motor side-effects, such as stiffness and tremors, than first-generation drugs. Whether or not this is true, however, is still debatable. Results from studies comparing the two types of drugs so far have not been reliable because of factors such as over-representation of men, and under-representation of people with other issues such as drug abuse, or because the trials were too short. The question is important for cost issues and for making treatment recommendations to doctors.

René Kahn at University Medical Centre, Utrecht, Netherlands, and colleagues did an open randomised trial in 14 countries ( 13 European countries and Israel ), which included 498 patients aged 18–40 years. The participants were randomly assigned to one low-dose first-generation drug ( Haloperidol ), or one of four higher-dose second-generation drugs [ Amisulpride ( Solian ), Olanzapine ( Zyprexa ), Quetiapine ( Seroquel ), or Ziprasidone ( Geodon ) ].

Over the following 12 months, more patients discontinued treatment in the Haloperidol group ( 63 individuals ), than in the others: Amisulpride ( 32 ), Olanzapine ( 30 ), Quetiapine ( 51 ), and Ziprasidone ( 31 ). However, the reductions in all symptoms were about the same for all groups, at around 60%.
When Researchers further analysed the data according to sex, tendencies towards suicide, and substance abuse, they found no significant differences between the drugs.

The Authors concluded that, although the high continuation rates for several of the second-generation antipsychotic drugs suggest that clinically meaningful long-term antipsychotic treatment is achievable in the first episode of schizophrenia, it cannot be concluded that second-generation antipsychotic drugs are more efficacious than Haloperidol in the treatment of these patients. ( Xagena )

Source: Lancet, 2008

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