Schizophrenia Drugs: Is Newer Better?
Study Shows New Drugs Have Similar Side Effects, but Expert Disagrees
In his own research comparing new and old schizophrenia drugs, including data presented at the 2000 annual meeting of the American College of Neuropsychopharmacology, Lieberman found that people diagnosed with their first episode of schizophrenia fare much better when treated with newer schizophrenia drugs than with older medications. And in treating his own patients, he says he finds the newer schizophrenia drugs to be more effective. "It could be that the numbers of the Lancet study indicate that there's little difference between both classes in preventing extrapyramidal side effects, but it's hard to believe, because we do see a difference," he tells WebMD.
Generally, he says, he prescribes the newer schizophrenia drugs to first-episode patients or those on older medications with a history of these movement problems. "But if people have done well on older medications and have not had intolerable side effects, there's usually no need to switch them."
However, previous studies indicate that about two in three people taking older schizophrenia drugs report these nerve and muscle side effects, and they are the primary reason for discontinuing treatment. One study presented at the European College of Neuropsychopharmacology's annual meeting in 1998 found nearly 90% of patients had these problems.
Lieberman also notes that the new Lancet findings come from a meta-analysis, a type of study in which previous research studies are reviewed in an attempt to make statistical comparisons. "But those findings are typically limited by nature to those previous studies -- how big it was, which treatments it includes, and the nature of the patient population," he tells WebMD. "They often compare one drug to another, so you don't have the advantage of comparing multiple treatments in the same study. And these drug-to-drug studies are largely sponsored by pharmaceutical companies, as opposed to more independent sponsors such as the government."
He is currently performing an 18-month trial on 1,500 patients using various schizophrenia drugs in both classes for the National Institute of Mental Health, but those results won't be completed for another year. "Hopefully, that will provide some definitive answers," he says.