Schizophrenia Drug Face-Off: No Clear Winner
Surprise Finding: Older Antipsychotics Can Be as Good as New Ones
Sept. 19, 2005 -- Mental health experts say it wasn't a horse race. That explains why there's no clear winner from a major government study pitting a new generation of schizophrenia drugs against one another.
Zyprexa was the most effective of the drugs. But its greater number of side effects dims its first-place finish.
Meanwhile, a come-from-behind, second-place finish by Trilafon -- a little-known old horse that nobody thought had a chance -- may rescue the older generation of schizophrenia drugs from being put out to pasture.
Funded by the National Institute of Mental Health (NIMH), the five-year study enrolled 1,500 schizophrenic patients at 27 U.S. medical centers. Neither patients nor their doctors knew whether they were getting Zyprexa, Seroquel, Risperdal, Geodon, or the older Trilafon. Jeffrey A. Lieberman, MD, now director of the New York Psychiatric Institute, led the study while at the University of North Carolina in Chapel Hill.
"These drugs work, but have limitations: 74% of patients in the study elected to seek something better rather than stay on their assigned medication," Lieberman said today at an NIMH news conference. "When it comes to treatment, the glass is only half full. ... We all want more efficacy and fewer side effects. But make no mistake: These drugs do work."
The study findings appear in the Sept. 22 issue of The New England Journal of Medicine.
'Traditional' Drug vs. Newer 'Atypical' Drugs
Schizophrenia is a frightening mental illness afflicting 3.2 million Americans. Usually beginning at age 18 to 24, patients suffer hallucinations, delusions, and disordered thinking. There is no cure. But treatments can greatly reduce the intensity of symptoms.
"Fifty years ago we would have been talking about people institutionalized in state hospitals," NIMH director Thomas R. Insel, MD, said at the news conference. "Then there came drugs, such as Thorazine and Haldol, which proved quite effective in reducing symptoms and the need for hospitalization."
These traditional antipsychotic drugs can have devastating side effects resembling Parkinson's disease: tremor, rigid muscles, and abnormal or restless movements.
About 12 years ago, the new generation of "atypical" antipsychotic drugs came along. These drugs were much less likely to cause Parkinson's-like side effects. But they came with side effects of their own -- extreme weight gain and an increased risk of type 2 diabetes Even so, 90% of schizophrenia prescriptions are for one of these six drugs.
Clinical trials show that the drugs work better than no drugs at all. But the trials never told doctors how the drugs would work relative to one another. That's why the NIMH sponsored the trial, known as the Clinical Antipsychotic Trials of Intervention Effectiveness or CATIE.
The trial included Trilafon to represent the traditional antipsychotic drugs. It also included four other atypical antipsychotics. Clozaril was not included in the first phase of the trial because it will be tested as a second-line treatment for patients who switch from one of the original drugs in the trial. Those results will be reported later.