Anti-psychotic drugs: Does newer mean better?

Overall, new drugs may not work any better at treating schizophrenia.  However, two recently published studies show doctors may be able to find ways to give patients the best alternative treatment sooner.

One of the studies, which was published in the American Journal of Psychiatry, advised of the importance in asking whether a patient quit taking their first drug because it was not working, or because it was causing side-effects.

A second study found that if patients can adhere to a treatment regimen, any treatment, they end up doing better in society than patients who stop for whatever reason.

Surprisingly, both of the U.S. government-funded studies show there really is no good drug for treating schizophrenia.  Schizophrenia is a mental disorder that affects about 1 percent of the population globally and 3.2 million Americans alone.

"We find again that the treatments we are using don't measure up all that well," Dr. Jeffrey Lieberman of Columbia University in New York, who led the study, told reporters in a telephone briefing.

The researchers used data from the $42.6 million CATIE (Clinical Antipsychotic Trials in Intervention Effectiveness) trial, paid for by the National Institute of Mental Health, to find if three of the newer schizophrenia drugs worked better than older drugs, or better than one another.

The data included Johnson & Johnson's risperidone, sold under the brand name Risperdal; olanzapine, made by Eli Lilly and Co. under the brand name Zyprexa; and quetiapine, made by AstraZeneca under the brand name Seroquel.

They looked at 114 patients who had quit taking the older drug perphenazine and who had been randomly assigned to take one of the newer drugs.

NEWER DOES NOT MEAN BETTER.

Most of the patients quit taking the new drugs too.

Patients taking Seroquel did not quit for 10 months on average, those on Zyprexa lasted seven months and those taking Risperdal quit on average after only four months.

Perphenazine can cause unpleasant side-effects including a movement disorder characterized by grimacing, eye blinking and other involuntary motions. However,  patients complained that the new drugs often made them sleepy, confused and caused weight gain.

Zyprexa was the drug that worked best if patients had stopped taking perphenazine because it did not control their schizophrenia symptoms, said Dr. T. Scott Stroup of the University of North Carolina.

"It confirms a clinical hunch that if a person doesn't do well on a drug, they do better if you try something really different," Stroup said.

"We hope we can help doctors choose these drugs sooner and promote recovery."

The second study, which was led by Dr. Marvin Swartz of Duke University in North Carolina, found that patients who stayed on one drug for a year or more had some improvements in social, interpersonal and community living skills.

Their study of 455 patients taking part in CATIE found it did not matter which drug they took.

"Patients were more able to function in the community if they were able to stick to treatment, especially the most impaired, although those were the most likely to drop out," Swartz said.

"We concluded from this that ... we need better drugs and better access to social services so that these patients can learn to function and to work in the community better," Swartz said.

More than 90 percent of prescriptions for anti-psychotics are for such second-generation drugs, accounting for $10 billion in U.S. sales each year.