Olanzapine Versus Ziprasidone: Results of a 28-Week Double-Blind Study in Patients With Schizophrenia

Breier, Alan; Berg, Paul H.; Thakore, Jogin H.; Naber, Dieter; Gattaz, Wagner F.; Cavazzoni, Patrizia; Walker, Daniel J.; Roychowdhury, Suraja M.; Kane, John M.

doi:10.1176/appi.ajp.162.10.1879

Cited by 132 publications

(125 citation statements)

References 27 publications

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“…The comparative efficacy and safety of olanzapine and ziprasidone was again assessed in a 28-week prospective, randomized, double-blind study (89,90). In it, 277 schizophrenia patients were randomized to olanzapine 10 to 20 mg daily (mean 15.27 mg daily, SD 4.52), and 271 schizophrenia patients were randomized to ziprasidone 80 to 160 mg daily (mean 115.96 mg daily, SD 39.91) at a standardized initial dose of each; any further clinically determined dose changes were performed according to standardized increments.…”

Section: Randomized Clinicalmentioning

confidence: 99%

The Metabolic Effects of Antipsychotic Medications

2006

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Objectives: To review current evidence for the hypothesis that treatment with antipsychotic medications may be associated with increased risks for weight gain, insulin resistance, hyperglycemia, dyslipidemia, and type 2 diabetes mellitus (T2DM) and to examine the relation of adiposity to medical risk. Methods:We identified relevant publications through a search of MEDLINE from the years 1975 to 2006, using the following primary search parameters: "diabetes or hyperglycemia or glucose or insulin or lipids" and "antipsychotic." Meeting abstracts and earlier nonindexed articles were also reviewed. We summarized key studies in this emerging literature, including case reports, observational studies, retrospective database analyses, and controlled experimental studies.Results: Treatment with different antipsychotic medications is associated with variable effects on body weight, ranging from modest increases (for example, less than 2 kg) experienced with amisulpride, ziprasidone, and aripiprazole to larger increases during treatment with agents such as olanzapine and clozapine (for example, 4 to 10 kg). Substantial evidence indicates that increases in adiposity are associated with decreases in insulin sensitivity in individuals both with and without psychiatric disease. The effects of increasing adiposity, as well as other effects, may contribute to increases in plasma glucose and lipids observed during treatment with certain antipsychotics. Conclusion:Treatment with certain antipsychotic medications is associated with metabolic adverse events that can increase the risk for metabolic syndrome and related conditions such as prediabetes, T2DM, and cardiovascular disease. Limitations· Currently, knowledge of the cost-effectiveness of different interventions to lower metabolic risk is limited. · Questions remain concerning how to implement clinical strategies that would improve quality and disparities of care in mental illness. · Future studies are needed to identify the mechanisms that allow medications to cause adiposity and changes in insulin sensitivity.

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Section: Randomized Clinicalmentioning

confidence: 99%

The Metabolic Effects of Antipsychotic Medications

2006

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“…The PANSS and PABPRS database (see Table 1) was composed of seven randomized, double-blind trials that compared olanzapine (Beasley et al, 1996aTollefson et al, 1997;Tran et al, 1997;Lieberman et al, 2003;Breier et al, 2005) or amisulpride (Sechter et al, 2002) with other antipsychotics or placebo.…”

Section: The Databasesmentioning

confidence: 99%

“…In the PANSS database, all studies provided CGI-severity ratings, but Breier et al, 2005;Sechter et al, 2002) provided only CGI-improvement ratings (n at baseline ¼ 1318). A description of the two CGI subscores is provided in Table 2.…”

Section: The Databasesmentioning

confidence: 99%

“…The following studies were included in the PANSS database: Beasley et al, 1996aBeasley et al, , b, 1997Tollefson et al, 1997;Tran et al, 1997;Sechter et al, 2002;Lieberman et al, 2003;Breier et al, 2005. baseline. In other words, does the same absolute/ percentage change of the BPRS/PANSS mean the same clinical improvement according to the CGI, if the patients were initially very severely ill or less severely ill?…”

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confidence: 99%

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Linking the PANSS, BPRS, and CGI: Clinical Implications

Leucht

Kane

Etschel

et al. 2006

Neuropsychopharmacol

259

172

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To understand what given scores of the Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale (PANSS) mean from a clinical point of view is important for the translation of research results into practice. We therefore (a) compared the absolute change of the BPRS/PANSS with the Clinical Global Impressions Ratings (CGI) -improvement score and the change of the CGI severity score, (b) analyzed whether the severity of illness at baseline had an impact on the latter association, and (c) attempted to replicate previous BPRS findings using a completely different data set based upon the PANSS-derived BPRS. The method used was equipercentile linking of BPRS and CGI ratings from 14 drug trials in acutely ill patients with schizophrenia (n ¼ 5970). An absolute reduction of the BPRS/PANSS by approximately 10/15 points corresponded to a CGI change of 'minimally improved' and to a change of the CGI severity score by one severity step. However, the latter associations depended on the severity of symptoms at baseline. Less severely ill patients required less BPRS/PANSS total score reduction to achieve the same CGI-improvement score than more severely ill patients. This effect of initial severity was attenuated using percentage rather than absolute BPRS/PANSS reduction scores.The linking analysis between the absolute BPRS/PANSS reduction and the CGI may have an implication for the interpretation of efficacy differences found in clinical trials, and for sample size estimations. Clinicians seem to base CGI ratings on relative change rather than on absolute change of symptoms.

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“…23 Study 2 (F1D-MC-HGHJ, Clinical Trial Registry #NCT00036088) was conducted at 79 sites in North and South America and Europe, and compared olanzapine and ziprasidone. 24 Study 3 (F1D-US-HGHO, completed before initiation of the Clinical Trial Registry) was conducted at 18 sites in the US, and compared olanzapine plus lorazepam with haloperidol plus lorazepam. 25 Studies 1 and 2 were both long-term trials, with Study 1 conducted over 12 months and Study 2 conducted over 28 weeks.…”

Section: Methods Studiesmentioning

confidence: 99%

Patient perspectives on antipsychotic treatments and their association with clinical outcomes

Liu‐Seifert

Osuntokun²,

Godfrey³

et al. 2010

PPA

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This analysis examined patient-reported attitudes toward antipsychotic medication and the relationship of these attitudes with clinical outcomes and pharmacotherapy adherence. The analysis included three randomized, double-blind studies in patients with schizophrenia, schizoaffective disorder, or schizophreniform disorder diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders 4th Edition and randomly assigned to treatment with olanzapine 5-20 mg/day or another antipsychotic (haloperidol 2-20 mg/day, risperidone 2-10 mg/day, or ziprasidone 80-160 mg/day). Patient-reported improvements were significantly greater for olanzapine (n = 488) versus other treatments (haloperidol n = 145, risperidone n = 158, or ziprasidone n = 271) on multiple Drug Attitude Inventory items. A positive attitude toward medication reported by patients was significantly associated with greater clinical improvement on the Positive and Negative Syndrome Scale and lower discontinuation rates. These results suggest that patients' perceptions of treatment benefits are associated with objective clinical measures, including reduction of symptom severity and lower discontinuation rates. Furthermore, olanzapine may be associated with more positive treatment attitudes. These findings may contribute to a better understanding of reasons for treatment adherence from patients' own perspectives.

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Olanzapine Versus Ziprasidone: Results of a 28-Week Double-Blind Study in Patients With Schizophrenia

Abstract: Olanzapine treatment resulted in significantly greater psychopathology improvement and higher response and completion rates than ziprasidone treatment, while ziprasidone was superior for weight change and lipid profile.

Cited by 132 publications

References 27 publications

The Metabolic Effects of Antipsychotic Medications

The Metabolic Effects of Antipsychotic Medications

Linking the PANSS, BPRS, and CGI: Clinical Implications

Patient perspectives on antipsychotic treatments and their association with clinical outcomes

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