Fran Lowry

June 07, 2016

SCOTTSDALE, Arizona ― Second-generation antipsychotics (SGAs) differ with regard to efficacy and side effect profiles for the treatment of first-episode psychosis, according to the results of a new meta-analysis and systematic review.

"Not all second-generation antipsychotics are created equal," Jianping (Jimmy) Zhang, MD, from the Zucker Hillside Hospital, Glen Oaks, New York, told Medscape Medical News.

"They have different side effect profiles, so when we treat patients, we have to consider both the efficacy as well as the side effects and individualize treatment to every patient," said Dr Zhang.

The findings were presented at the Society of Clinical Psychopharmacology (ASCP) 2016 Annual Meeting.

Side Effects Differ

The investigators conducted a meta-analysis of 20 randomized, head-to-head trials comparing the use of SGAs in the treatment of first-episode psychosis that were published through October 31, 2015.

The primary outcomes were total psychopathology change, response rate, and all-cause discontinuation.

The meta-analysis, which included 2995 patients, compared the following SGAs: olanzapine (multiple brands), risperidone (Risperdal, Janssen Pharmaceuticals, Inc), quetiapine (Seroquel, AstraZeneca Pharmaceuticals, LP), ziprasidone (Geodon, Pfizer Inc), and aripiprazole (Abilify, Otsuka Pharmaceutical Co, LP).

Olanzapine and risperidone were significantly better than quetiapine for total symptom reduction (P < .05 for both).

There were no significant differences in response rates and all-cause discontinuation rates with any of the SGAs.

Olanzapine and risperidone consistently outperformed quetiapine in reducing positive symptoms. Aripiprazole was slightly better at reducing negative symptoms, said Dr Zhang.

"We really have to consider the side effects of these different medications," he added.

"For example, although olanzapine is probably one of the most effective antipsychotics in both chronic patients as well as in the first-episode patients, it causes tremendous weight gain, so we don't usually recommend using olanzapine as a first-line treatment because of the metabolic consequences," he said.

"In our hospital, our practice has been to start with risperidone, because it is effective, with relatively benign side effects, although the extrapyramidal symptoms can be pretty bad, and it's cheap. It has been generic for many years," said Dr Zhang said.

Useful Data

Commenting on the findings for Medscape Medical News, Stanley N. Caroff, MD, professor, Perelman School of Medicine, University of Pennsylvania, in Philadelphia, said the study "comes from a very reliable, highly accurate research data group addressing very fundamental and practical questions that clinicians need to face.

"Dr Zhang provided very useful data that are evidence-based on the relative efficacy and side effects of each agent, and this can really help clinicians to individualize their choice of antipsychotics to the specific needs of each patient," he said.

The study was sponsored by the National Institute of Mental Health. Dr Zhang and Dr Caroff have disclosed no relevant financial relationships.

American Society of Clinical Psychopharmacology (ASCP) 2016 Annual Meeting: Abstract 3000630, presented June 1, 2016.

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