Healthy Skepticism Library item: 7071

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Publication type: Journal Article

Hopkins-Tanne J
Newer antipsychotic drugs are no better than older ones, study finds
BMJ 2006 Oct 14; (333):771
http://www.bmj.com/cgi/content/full/333/7572/771

Abstract:

Older antipsychotic agents are just as effective as the newer, more expensive “second generation” agents, a new study concludes.

The newer drugs, which are almost twice as expensive as the older ones, are no more likely to improve quality of life, say the researchers, from the University of Cambridge and other centres in England (Archives of General Psychiatry 2006;63: 1079-87[Abstract/Free Full Text]).

The study, which was funded by the NHS, reviewed 227 patients aged 18 to 65 years who were users of 14 community psychiatric services in England. The patients had schizophrenia and related disorders and needed a change in treatment.

The authors wrote, “The key question was whether the additional acquisition costs of second generation agents over first generation agents would be offset by improvements in health-related quality of life or savings in the use of other health and social care services in people with schizophrenia for whom a change in drug treatment was being considered for clinical reasons, most commonly subobptimal efficacy or adverse effects.”

In the double blinded, controlled trial patients were randomised to receive either first generation or second generation antipsychotic drugs. The second generation drugs, the authors wrote, “are perceived to be more effective, with fewer side effects, and preferable to patients.”

The first generation drugs included chlorpromazine, flupentixol, haloperidol, loxapine, levomepromazine, sulpiride, trifluoperazine, zuclopenthixol, and depot preparations of fluphenazine decanoate, flupentixol decanoate, haloperidol, pipotiazine palmitate, and zuclopenthixol decanoate.

The second generation drugs included risperidone, olanzapine, amisulpride, zotepine, and quetiapine.

Quality of life scales widely used in psychopharmacological treatments for schizophrenia were used to evaluate the participants who underwent blind assessments at baseline and at 12, 26, and 52 weeks after their first randomised treatment. The investigators were able to follow up 185 of the patients (81%) at one year: 100 who had been randomised to treatment with first generation drugs and 85 randomised to second generation drugs.

The results showed that second generation antipsychotics were no better than the older drugs in improving quality of life.

The costs associated with treatment over the follow-up period were similar in the two groups. The major cost in both groups was admission to psychiatric hospitals, accounting for 93% of costs among patients taking the older drugs and 82% of the costs among those taking the newer drugs.

The drugs themselves accounted for only 2% of total costs among those taking the older drugs and 4% of costs among those taking the newer drugs.

The researchers concluded that patients have no disadvantage in terms of quality of life, symptoms, or associated costs of care in a year after starting treatment with first generation antipsychotic drugs rather than second generation drugs when treatment is being changed.

Rapid Responses:
Read all Rapid Responses

Older, cheaper antipsychotics
James W Hawkins
bmj.com, 13 Oct 2006 [Full text]
Similar conclusion from Scotland
Stewart M Herring
bmj.com, 14 Oct 2006 [Full text]
Keep the debate open
Joseph More
bmj.com, 14 Oct 2006 [Full text]
Real world validity problems
Ian Pennell
bmj.com, 14 Oct 2006 [Full text]
Efficacy of SGA’s
Ivor P Hodgson
bmj.com, 16 Oct 2006 [Full text]
Newer Antispychotics simply better for patients
Charles O Olojugba, et al.
bmj.com, 17 Oct 2006 [Full text]
First Generation Antipsychotics and Social Stigma
Ndidi O Ihezue
bmj.com, 17 Oct 2006 [Full text]
Newer antipsychotics and dosage regimen
Augusta .O Obamwonyi
bmj.com, 18 Oct 2006 [Full text]
How Cost effective are newer antipsychotics ?
Olukayode.S Majekodunmi
bmj.com, 18 Oct 2006 [Full text]
newer antipsychotics and new problems
olusola olaloko
bmj.com, 21 Oct 2006 [Full text]