-Pharmalot

03/28/2008 - The so-called atypicals - including Abilify, Risperdal, Zyprexa, Seroquel and Geodon - have been hailed as more effective and easier to tolerate than the older and cheaper kind such as Haldol, which cause tremors and rigid muscles. But the new generation are no better at treating a first episode of schizophrenia, according to a study in The Lancet. Such findings are important because the atypicals are heavily promoted, widely prescribed and expensive.

The Dutch researchers studied 498 patients between 18 and 40 years old in Europe and Israel in an open trial lasting 12 months. The patients were randomly assigned to a low-dose version of Haldol, or a higher dose of one of four atypicals. They found that during the subsequent 12-month period, more patients taking Haldol discontinued treatment when compared with patients taking the other drugs.

However, the reductions in all symptoms were about the same for all groups. But when the researchers further analyzed the data according to sex, tendencies towards suicide, and substance abuse, they found no significant differences between the drugs. Despite a high continuation rate for several of the atypicals, the researchers wrote that “it cannot be concluded that second-generation antipsychotic drugs are more efficacious in the treatment of these patients.”

As an aside, many of the authors reported various ties to the drugmakers that sell atypicals. And funding for the study was provided by AstraZeneca, Pfizer and Sanofi-Aventis.