Latest Antipsychotic Drugs Not Necessarily the Greatest

Once celebrated as a major breakthrough in the treatment of schizophrenia, atypical or second-generation antipsychotics (SGAs) may not be nearly as effective as once thought. According to a study published this week in the Archives of General Psychology, the more-expensive SGAs have not been shown to have any clinical advantage when compared to typical or first-generation antipsychotics (FGAs). 

According to the published article, based on a study commissioned by Britain’s National Health Service, “there is no disadvantage in terms of quality of life, symptoms, or associated costs of care across one year in commencing treatment with FGAs rather than atypical SGAs in people with schizophrenia…” Rather than finding clinical superiority for SGAs, the “analysis indicated that true effects may have been in the opposite direction…,” the study concluded. The 227 subjects covered were patients with schizophrenia whose medication was changed because of ineffectiveness or harmful side effects.

“All the data suggest that careful prescribing of FGAs, at least in the context of a trial, is not associated with poorer efficacy or a greater adverse effect burden, both of which would translate into lower quality of life in the medium term,” the authors claim. They suggested that the role of SGAs in the treatment of schizophrenia continue to be evaluated. SGAs such as Zyprexa, Risperdal, and Seroquel are far costlier (as much as 10 times costlier) than FGAs that might be equally as effective in treating the disease. 

In a commentary also published in the Archives this month, Columbia University’s J.A. Lieberman said plainly, “With the possible exception of clozapine, the second-generation antipsychotics are not the great breakthrough in therapeutics they were once thought to be.” Lieberman conducted his own study in the U.S. last year, and a 2003 Department of Veterans’ Affairs study concluded much the same thing. 

“These studies found few differences in effectiveness between first-generation antipsychotics and second-generation antipsychotics in nonrefractory patients–a conclusion that runs counter to the impressions of many clinicians and previous studies suggesting marked superiority of the second-generation antipsychotics and that belies the huge advantage in market share enjoyed by the second-generation antipsychotics in the United States and other parts of the world,” according to Dr. Lieberman. 

Lieberman blames the exaggeration of the benefits of second-generation drugs on a combination of forceful marketing by the drugs’ producers and a general bias toward new medications by the medical community.

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