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How effective is it to sequentially switch among Olanzapine, Quetiapine and Risperidone?—A randomized, open-label study of algorithm-based antipsychotic treatment to patients with symptomatic schizophrenia in the real-world clinical setting

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Abstract

Rationale

Evidence on sequential trial with atypical antipsychotics has been scarce.

Objectives

We conducted an algorithm-based antipsychotic pharmacotherapy.

Materials and methods

In this open-label study, patients with schizophrenia (DSM-IV) were treated with antipsychotic monotherapy, step-by-step, with each trial lasting up to 8 weeks. At baseline, they were highly symptomatic to score more than 54 in the total Brief Psychiatric Rating Scale (BPRS1–7) score. When the posttreatment BPRS score was above 70% of the baseline, they were subsequently treated with another and up to three atypicals. Basically, anticholinergics were prohibited, and only adjunctive allowed was lorazepam. The secondary endpoint was a clinical status good enough to be discharged for 66 inpatients and a successful continuation therapy with the same antipsychotic agent for more than 6 months for 12 outpatients.

Results

Three groups of 26 patients each were randomized to Olanzapine, Quetiapine, or Risperidone. Thirty-nine (50%) responded to the first agent (Olanzapine16, Quetiapine9, Risperidone14), and 14 responded to the second. Only two showed response to the third, and 16 failed to respond to all three antipsychotics, with only 7 dropouts. Overall, there were 22 Olanzapine, 14 Quetiapine, and 19 Risperidone responders. Based on the secondary outcome, 20 Olanzapine-treated (average maximum dose, 15.4 mg), 10 Quetiapine-treated (418 mg), and 20 Risperidone-treated (4.10 mg) patients responded. The difference in response as the first choice was significant (p < 0.05). Relative doses of those failing to respond were comparable (Olanzapine 18.3 mg, Quetiapine 564 mg, Risperidone5.47 mg). Extrapyramidal symptoms did not change significantly.

Conclusions

When the first atypical antipsychotic is inadequate, switching to the second is worth trying, although some remain treatment-refractory. Quetiapine may be inferior to Olanzapine and Risperidone in symptomatic patients.

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Acknowledgment

This work was presented in part at the XXVth Collegium Internationale Neuro-psychopharmacologicum Congress (2006, Chicago). This study was independent from any financial support.

Conflict of interest statement

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Authors and Affiliations

  1. Department of Neuro-Psychiatry, School of Medicine, Keio University, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Takefumi Suzuki, Hiroyuki Uchida, Koichiro Watanabe, Kensuke Nomura, Hiroyoshi Takeuchi, Masayuki Tomita, Kenichi Tsunoda, Shintaro Nio, Ryoske Den, Hiroshi Manki, Gohei Yagi & Haruo Kashima

  2. Centre for Addiction and Mental Health, PET Centre, 250 College Street, Toronto, Ontario, M5T 1R8, Canada

    Hiroyuki Uchida

  3. Department of Psychiatry, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan

    Akira Tanabe

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  1. Takefumi Suzuki
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  2. Hiroyuki Uchida
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  3. Koichiro Watanabe
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  4. Kensuke Nomura
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  5. Hiroyoshi Takeuchi
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  7. Kenichi Tsunoda
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  11. Akira Tanabe
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  12. Gohei Yagi
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  13. Haruo Kashima
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Correspondence to Takefumi Suzuki.

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Suzuki, T., Uchida, H., Watanabe, K. et al. How effective is it to sequentially switch among Olanzapine, Quetiapine and Risperidone?—A randomized, open-label study of algorithm-based antipsychotic treatment to patients with symptomatic schizophrenia in the real-world clinical setting. Psychopharmacology 195, 285–295 (2007). https://doi.org/10.1007/s00213-007-0872-2

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  • DOI: https://doi.org/10.1007/s00213-007-0872-2

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