Posted by river1924 on October 24, 2006, at 10:55:45
First- and Second-Generation Antipsychotics Yield Similar Clinical Outcomes
NEW YORK (Reuters Health) Oct 02 - Previous trial results to the contrary, second-generation antipsychotic drugs offer no advantage over first-generation antipsychotics, either in efficacy, quality of life, or overall cost of care, according to the results of a British study published in the Archives of General Psychiatry for October.When the second-generation drugs were introduced, clinical trial results supported their superiority in terms of reducing negative symptoms and improving cognition with fewer extrapyramidal symptoms and better tolerability, Dr. Peter B. Jones, at the University of Cambridge, and his associates state.
In contrast, they say, two systematic reviews concluded that the two classes of drugs are generally equivalent in treating positive symptoms. Moreover, meta-analyses have raised questions regarding the size and duration of the clinical trials and the significance of their effects.
To ferret out any differences in how first- and second-generation antipsychotics actually perform, Dr. Jones' team designed a clinical trial that included patients with schizophrenia, schizoaffective disorder or delusional disorder, whose medication was being changed, either because of suboptimal efficacy or side effects. They note that their trial was funded by the UK National Health Service, and received no support from the pharmaceutical industry.
Patients were randomized to treatment with a first-generation drug (n = 118) or a second-generation drug (n = 109). Other than assignment to a specific class of medication, the trial was designed to reflect normal clinical practice, with the 73 referring physicians free to prescribe any of the drugs in the class to which their patient had been assigned.
The primary outcome, Quality of Life Scale score, did not differ significantly between groups at the 12-, 26- and 52-week follow-up visits.
The authors observed a trend favoring the older agents in costs over the 52 weeks of the trial: roughly $35,000 for first-generation and $37,000 for second-generation antipsychotics. The costs were due primarily to psychiatric hospital inpatient admissions.
Furthermore, no between-group difference was seen in any of the secondary outcomes, i.e., the Positive and Negative Syndrome Scale score, Global Assessment of Functioning scale, or tests evaluating depression, compliance, extrapyramidal symptoms, and akathisia.
Finally, the subjects themselves showed no clear preference for either class of the drugs.
Arch Gen Psychiatry 2006;63:1079-1087.
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