Amisulpride as Good as Risperidone in Chronic Schizophrenia

Laurie Barclay, MD

January 08, 2003

Jan. 8, 2003 — Amisulpride is at least as good as risperidone and may even be superior in terms of response in chronic schizophrenia, according to the results of a six-month, double-blind, randomized study reported in the December issue of Neuropsychopharmacology.

"Both treatments were well tolerated and had a similar low incidence of extrapyramidal symptoms; however, amisulpride was associated with less weight gain and endocrine/sexual symptoms," write Daniel Sechter, from the Saint-Jacques Hospital in Besancon, France, and colleagues.

In this noninferiority trial, 309 patients with chronic schizophrenia by DSM-IV criteria and recent worsening of symptoms received amisulpride, 400 to 1,000 mg/day, or risperidone, 4 to 10 mg/day, for six months.

Amisulpride was not inferior to risperidone with respect to the decrease from baseline in Positive and Negative Syndrome Scale (PANSS) total score (90% two-sided confidence interval [-5.6; 4.0]). Both groups were similar in symptomatic improvement measured with the Brief Psychiatry Rating Scale (BPRS), the PANSS positive subscale, and the Bech Rafaelsen Melancholia Scale.

Response was significantly better (P < .05) for amisulpride compared with risperidone in terms of achieving at least a 50% improvement in PANSS and BPRS total scores, or a rating of "very much" or "much improved" on the Clinical Global Impression Scale. Functional effects and subjective response were also better with amisulpride.

"Maintenance of the therapeutic effect, response rates, social adaptation, and patient subjective response did show significant advantages of amisulpride over risperidone," the authors write. "Neurological safety was excellent.... These findings are consistent with those from previous studies showing that the atypical antipsychotics are associated with a lower incidence of extrapyramidal symptoms than the typical neuroleptics."

Sanofi-Synthelabo sponsored this study.

Neuropsychopharmacology. 2002;27:1071-1081

Reviewed by Gary D. Vogin, MD

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