Long-term (3-year) effectiveness of haloperidol, risperidone and olanzapine: results of a randomized, flexible-dose, open-label comparison in first-episode nonaffective psychosis
- 403 Downloads
To enhance the effectiveness of antipsychotics in first-episode psychosis is crucial in order to achieve the most favourable prognosis. Difference in effectiveness between antipsychotics is still under debate.
The purpose of this study is to determine the long-term (3-year) effectiveness and efficacy of haloperidol, risperidone and olanzapine in first-episode schizophrenia-spectrum disorders.
This is a prospective, randomized, open-label study. Data for the present investigation were obtained from a large epidemiologic and 3-year longitudinal intervention programme of first-episode psychosis. One hundred seventy-four patients were randomly assigned to haloperidol (N = 56), olanzapine (N = 55), or risperidone (N = 63) and followed up for 3 years. The primary effectiveness measure was all-cause of treatment discontinuation. In addition, an analysis based on per-protocol populations was conducted in the analysis for clinical efficacy.
The treatment discontinuation rate for any cause differed significantly between treatment groups (χ2 = 10.752; p = 0.005), with a higher rate in haloperidol than in risperidone and olanzapine. The difference in the discontinuation rate between risperidone and olanzapine showed a tendency towards significance (χ2 = 3.022; p = 0.082). There was a significant difference in the mean time to all-cause discontinuation between groups (log-rank χ2 = 12.657;df = 2; p = 0.002). There were no significant advantages to any of the three treatments in reducing the psychopathology severity.
After 3 years of treatment, a lower effectiveness was observed in haloperidol compared to second-generation antipsychotics (SGAs). The use of SGAs for the treatment of early phases of nonaffective psychosis may enhance the effectiveness of antipsychotics.
KeywordsAntipsychotics Schizophrenia Treatment Efficacy Clinical practice
- Addington D, Addington J, Malika-tyndale E (1993) Assessing depression in schizophrenia: the Calgary Depression Scale. Br J Psychiatry (Suppl) 22:39–44Google Scholar
- Andreasen NC (1983) Scale for the Assessment of Negative symptoms (SANS). University of Iowa, Iowa CityGoogle Scholar
- Andreasen NC (1984) Scale for the Assessment of Positive symptoms (SAPS). University of Iowa, Iowa CityGoogle Scholar
- Crespo-Facorro B, Perez-Iglesias R, Mata I et al (2011) Effectiveness of haloperidol, risperidone and olanzapine in the treatment of first-episode non-affective psychosis: results of a randomized, flexible-dose, open-label 1-year follow-up comparison. J Psychopharmacol 25:744–754PubMedCrossRefGoogle Scholar
- First MB, Spitzer RL, Gibbon M, William JB (2001) Structured Clinical Interview for DSM-IV-TR Axis I Disorders—non-patient edition. Biometrics Research Department, New YorkGoogle Scholar
- Guy W (1976) ECDEU Assessment manual for psychopharmacology. US Department of Health, Education, and Welfare publication ADM 76338. National Institute of Mental Health, Washington, DC, pp 217–222Google Scholar
- Janca A, Kastrup M, Katschnig H et al (1996) The World Health Organization Short Disability Assessment Schedule (WHO DAS-S): a tool for the assessment of difficulties in selected areas of functioning of patients with mental disorders. Soc Psychiatry Psychiatr Epidemiol 31:349–354PubMedCrossRefGoogle Scholar
- Lieberman JA (1996) Atypical antipsychotics drugs as a first-line treatment of schizophrenia: rationale and hypothesis. J Clin Psychiatry (Suppl) 11:68–71Google Scholar
- Overall JE, Gorham DR (1962) The Brief Psychiatric Rating Scale. Psychol Rep 10:799–812Google Scholar