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NIH Study Finds No Clear or Easy Choice in Schizophrenia Drugs

UR researchers and patients took part in large research trial

Monday, September 19, 2005

New and more costly drugs for the treatment of schizophrenia are not substantially better than a 50-year-old medication, according to a large study funded by the National Institute of Mental Health.

The University of Rochester Medical Center was one of the more than 50 sites that were part of the trial. J. Steven Lamberti, M.D., associate chairman for clinical programs in the Medical Center’s Department of Psychiatry, was the site principal investigator for the project.

“The winner in this study may be perphenazine,” Lamberti said. “Although it is the oldest and least expensive medication, it was as effective as all of the other medications except for olanzapine and it had fairly good tolerability.”

The study results confirm clinical impressions that olanzapine is the most effective drug among those studied, although it has a greater degree of metabolic side effects, he said.

“That finding is consistent with findings in other fields of medicine, where the most effective medications tend to have more side effects than the less effective ones,” Lamberti said.

The research provides new information that will help doctors and patients choose the most appropriate medication.

The study, which included 32 people at the Medical Center, involved more than 1,400 patients across the country.

The results will be published in this week’s issue of the New England Journal of Medicine. The NIMH released the study results today.

In the trial – known as Clinical Antipsychotic Trials of Intervention Effectiveness -- researchers directly compared an older medication available since the 1950s and known as perphenazine to four newer medications, olanzapine, quetiapine, risperidone, and ziprasidone, which were introduced in the 1990s. These newer medications, known as atypical antipsychotics, cost roughly 10 times as much as the older medications.

Almost three quarters of people in the study switched from their first medication to a different medication. The high rate with which participants discontinued their drug indicates the substantial limitations in the effectiveness of the drugs, the researchers concluded.

Patients started on olanzapine were less likely to be hospitalized for a psychotic relapse and tended to stay on the medication longer than patients taking other medications. However, olanzapine, more than the other drugs, was associated with metabolic changes related to an increased risk of diabetes. Patients who took olanzapine also had greater weight gain and increases in cholesterol and triglycerides.

Schizophrenia affects 3.2 million Americans. It is a chronic mental illness, characterized by hallucinations and delusions. Those with the disease have difficulty telling the difference between real and unreal experiences, to think logically, to have normal emotional responses to others, and to behave normally in social situations.

Jeffrey Lieberman, M.D., chairman of the Department of Psychiatry at Columbia University and director of the New York State Psychiatric Institute, was the study’s principal investigator.


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