Atypical Antipsychotics Offer Modest Therapeutic Advantage. (beyond Superior Side Effect Profile)
Sherman, Carl, Clinical Psychiatry News
NEW YORK -- Atypical antipsychotics are clearly superior to conventional drugs in side effect profile, particularly extrapyramidal symptoms, but differences in clinical response are less dramatic than might be hoped, Dr. Jean-Pierre Lindenmayer said at a conference on psychopharmacology sponsored by New York University.
"Are we out of the schizophrenia woods? Not by a long shot. ... We need better drugs that are effective in all schizophrenia domains, that patients like to take, and that have effects on functional outcomes, not just on symptoms," said Dr. Lindenmayer, clinical director of the Manhattan Psychiatric Center, New York.
The use of atypical antipsychotics has increased dramatically in recent years, virtually doubling in New York state psychiatric facilities, for example, from 32% of antipsychotic prescriptions in 1998 to 61% in 2000. But the superiority of the newer drugs is difficult to characterize.
Reviewing key studies in which these drugs were compared with conventional neuroleptics and with one another, Dr. Lindenmayer reported that differences in efficacy are perhaps less than is generally thought. In resolution of positive symptoms, risperidone appears as good as and possibly better than conventional antipsychotics, while olanzapine is equal to them, and ziprasidone and quetiapine are no better and possibly worse. For negative symptoms, all four first-line atypicals are equal to or better than older drugs.
In most studies, the improvements seen with atypicals were "highly significant, but not huge," he said. In a trial of risperidone, for example, the decline in positive and negative symptoms over an 8-week period was 4. …