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New Drug Beats Old for Schizophrenia

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Jan. 2, 2002 -- Doctors often reach for new drugs when it comes to treating people with schizophrenia. But do they really work better than the old standbys? A new study suggests that they do.

Since the 1950s, Haldol has helped many people with schizophrenia. However, its severe side effects -- including restlessness, spasms, drooling, tremor, and involuntary facial tics -- can be very difficult for patients and their families.

Newer drugs don't have as many side effects but are a lot more expensive. Are they worth it? At least one is, says a study appearing in the Jan. 3 issue of The New England Journal of Medicine (NEJM). It shows that one of the new drugs -- Risperdal -- works a lot better than Haldol.

John G. Csernansky, MD, of Washington University in St. Louis, and colleagues studied 365 adults with schizophrenia. All were stable at the time they began the study. About half the people received Risperdal and the other half received Haldol. Neither the patients nor their doctors knew which drug they were getting.

For lots of people, neither drug worked very well. Nearly half of the Risperdal patients and more than half of the Haldol patients stopped taking their medication for reasons other than schizophrenia relapse. More than a third of patients in the Risperdal group relapsed. Even so, they did better than the Haldol patients, 60% of whom relapsed.

Csernansky and co-workers warn that not all of the new schizophrenia drugs work the same. Thus, the results of the study may not hold true for other drugs similar to Risperdal, such as Zyprexa.

In an editorial in the same issue of the NEJM, John Geddes, MD, of the University of Oxford, England, says that the study means Risperdal is the drug of first choice for treating schizophrenia. However, he notes that this study -- like nearly every study of schizophrenia drugs -- was paid for by the drug's manufacturer. Such studies help manufacturers get FDA approval. Geddes argues that they don't help doctors answer their most important question: Which drugs work best for which patients?

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