Friday April 18 2008
CEA
First-episode mania* : first or second-generation anti-psychotics ?**
Lancet. 371:1085-1097
CEA
To assess whether second-generation ant-psychotics are superior to first-generation anti-psychotics in terms of efficacy and tolerance: economic and public health issues
A team of researchers from I²BM-based CI-NAPS working in partnership with the European schizophrenia research network has just demonstrated the therapeutic benefits of second-generation anti-psychotics for patients presenting with first-episode mania. The study nevertheless remains inconclusive on the superiority of anti-symptomatic action of second-generation anti-psychotics compared to more conventional first-generation anti-psychotics like haloperidol.
The study population of 498 patients presenting first-episode mania was randomized into 5 groups to receive a 12-month therapy based on either haloperidol (1-4 mg/day – group 1), amisulpride (200-800 mg/day – group 2), olanzapine (5-20 mg/day – group 3), quetiapine (200-750 mg/day – group 4) or zipradisone (40-160 mg/day – group 5).
The authors cross-compared the 5 groups in terms of all-cause treatment discontinuation rates:
èfar lower discontinuation rates under second-generation anti-psychotics (40% for amisulpride, 33% for olanzapine, 53% for quetiapine and 45% for ziprasidone) than in the group taking the first-generation anti-psychotic haloperidol (72%).
èlower rates under second-generation anti-psychotics than under haloperidol, although there was no significant difference between haloperidol and quetiapine (48% for haloperidol, 14% for amisulpride, 14% for olanzapine, 40% for quetiapine and 26% for ziprasidone).
The authors also reported similar between-group treatment efficacy in terms of symptom reductions, at around 60%.
Between-group comparison of side effects-driven treatment discontinuation rates:
è no significant differences between the 5 groups.
This study demonstrates clinical benefits of second-generation anti-psychotic drugs for patients presenting first-episode mania, but remains inconclusive on whether these drugs offer superior anti-symptomatic action compared to first-generation anti-psychotics. This study is expected to curb the fad towards second-generation anti-psychotics. These results will need to be factored into the guidelines on prescription labels for anti-psychotics for patients presenting first-episode schizophrenia – guidelines that are currently attracting criticism.
Ref: Kahn RS, Fleischhacker WW, Boter H, Davidson M, Vergouwe Y, Keet IP, Gheorghe MD, Rybakowski JK, Galderisi S, Libiger J, Hummer M, Dollfus S, López-Ibor JJ, Hranov LG, Gaebel W, Peuskens J, Lindefors N, Riecher-Rössler A, Grobbee DE; EUFEST study group (2008). Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial. Lancet. 371:1085-1097
* First-episode schizophrenia, or early schizophrenia
** Anti-psychotics, or ‘neuroleptics’, are drugs used to reduce the symptoms of psychosis
Contact:Sonia Dollfus