Older Antipsychotic Medications for Schizophrenia as Effective as Newer, More Costly Treatments, Report Finds

Schizophrenia patients who take older antipsychotic drugs have a slightly higher quality of life than patients who are treated with drugs approved more recently, according to a study published in the Archives of General Psychiatry, the Washington Post reports. For the study, which was requested by Britain's National Health Service and funded by the British government, researchers at the University of Cambridge randomly treated 227 schizophrenia patients with either an older antipsychotic drug or a newer one such as Zyprexa, Risperdal or Seroquel. The patients were evaluated for more than one year by experts who did not know what drug had been provided. The researchers had expected that a quality-of-life scale would show a five-point advantage for patients on newer drugs, but instead they found that quality of life was slightly better for patients taking older drugs.

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Peter Jones, leader of the study and a psychiatrist at Cambridge, said that a conservative interpretation of the data suggested that there is no difference between older and newer antipsychotic drugs, "so the notion you would pay 10 times as much [for a newer drug] would be difficult to justify." Jones said there are several reasons why psychiatrists generally believe that newer drugs are superior. "I think pharmaceutical companies did a great job in selling their products," Jones said. In addition, he said, "It became almost a moral issue on whether you would prescribe these dirty old drugs. It became a 'my son' phenomenon. What would you prescribe for your son?" Jeffrey Lieberman, a Columbia University psychiatrist in an accompanying editorial said, "The claims of superiority for the (newer drugs) were greatly exaggerated." Lieberman added that doctors and patients are "eager to believe in the power of new medications" and that "the aggressive marketing of these drugs may have contributed to this enhanced perception of their effectiveness in the absence of empirical information." Darrell Regier, research director for the American Psychiatric Association, said a "thoughtful and prolonged process" is necessary before changing treatment guidelines. Carole Puls -- a spokesperson for Eli Lilly, the manufacturer of Zyprexa -- said that it is difficult to compare large groups of medications because there are differences between drugs in each class. Puls said individual patients need different treatment options. Janssen Pharmaceutica, which makes Risperdal, and AstraZeneca, which makes Seroquel, did not respond to requests for comment (Vedantam, Washington Post, 10/3).
The study is available online.