Effectiveness of haloperidol, risperidone and olanzapine in the treatment of first-episode non-affective psychosis: results of a randomized, flexible-dose, open-label 1-year follow-up comparison

Abstract

The aim of this study was to investigate the long-term effectiveness and efficacy of haloperidol, risperidone and olanzapine in first-episode schizophrenia-spectrum disorders. This was a prospective, randomized, open-label study. Data for the present investigation were obtained from a large epidemiological and 3-year longitudinal intervention programme of first-episode psychosis conducted at the University Hospital Marques de Valdecilla, Santander, Spain. One hundred and seventy-four patients were randomly assigned to haloperidol (N = 56), olanzapine (N = 55), or risperidone (N = 63) and followed up for 1 year. The primary effectiveness measure was all causes of treatment discontinuation. Effectiveness analyses were based on intend-to-treat populations. In addition, an analysis based on per protocol populations was conducted in the analysis for clinical efficacy. The treatment discontinuation rate for any cause was higher with haloperidol than with risperidone and olanzapine (χ(2) = 8.517; p = 0.014). The difference in discontinuation rate between risperidone and olanzapine was not significant (χ(2) = 0.063; p = 0.802). There were no significant advantages of any of the three treatments in reducing the severity of psychopathology. Risperidone and olanzapine demonstrated higher effectiveness relative to haloperidol, but the three antipsychotics were equally effective in reducing the severity of psychopathology. Specific clinical programmes and the use of second-generation antipsychotics may enhance the effectiveness of antipsychotic treatments.

Long-term (3-year) effectiveness of haloperidol, risperidone and olanzapine: results of a randomized, flexible-dose, open-label comparison in first-episode nonaffective psychosis

“…Less clear seems to be the notion that some of the SGAs might be more effective (in terms of treatment discontinuation) than others. Most of the short-term randomized studies have shown similar rates of allcause treatment discontinuation in first-episode patients treated with different SGAs (Crespo-Facorro et al 2011;Kahn et al 2008;McEvoy et al 2007). In our study, the difference in discontinuation rates at 3 years between olanzapine (50.9%) and risperidone (66.7%) did not reach a statistical significance, but we believe it should be considered as clinically relevant.…”

“…(1 year) follow-up studies had shown a higher rate of discontinuation in patients initially assigned to haloperidol (Crespo-Facorro et al 2011;Green et al 2006;Kahn et al 2008). Nonetheless, not all studies have found a higher effectiveness of SGAs compared to FGA, and a similar effectiveness between risperidone and haloperidol has been also described at both 1-year (Gaebel et al 2007) and at 2-year (Schooler et al 2005) follow-ups.…”

“…Clinical effectiveness is determined by both efficacy and tolerability, and it applies to patients in real-world treatment settings. In first episode of psychosis, similar clinical efficacy has been found between second generation of antipsychotics (SGAs) and low doses of first-generation antipsychotics (FGAs; Crespo-Facorro et al 2006, 2011Kahn et al 2008;Lieberman 1996;Lieberman et al 2003). The existence of differences in safety and tolerability leads to different treatment discontinuation rates among antipsychotics in the short term.…”

“…Detailed analysis of treatment efficacy at 6 weeks and 1 year in this population has been previously reported (Crespo-Facorro et al 2006, 2011.…”

“…Previous randomized open-label (Crespo-Facorro et al 2011;Kahn et al 2008) and double-blind studies (Schooler et al 2005;Gaebel et al 2007;Green et al 2006;McEvoy et al 2007) have drawn inconclusive results as to the differential effectiveness of SGAs compared to FGAs in first-episode psychosis. Most of these previous studies assessed the effectiveness in the medium term (1 year) (Crespo-Facorro et al 2011;Kahn et al 2008;McEvoy et al 2007;Schooler et al 2005). However, and due to fact that side effect profile (tolerability) may change over time, studies based on longer follow-up periods comparing the effectiveness of SGAs and FGAs in routine clinical settings may shed new light on the effectiveness of antipsychotics in early phases of schizophrenia.…”