Risperidone versus olanzapine among patients with schizophrenia participating in supported employment: Eighteen-month outcomes

Abstract

This study compares the efficacy and tolerability of olanzapine versus risperidone among patients with schizophrenia who are established in outpatient psychiatric care and entering supported employment. A multicenter, randomized, double-blind trial was conducted among 107 outpatients with schizophrenia, who were cross-titrated to flexible dose risperidone or olanzapine over 2 weeks. Clinical endpoints included time to hospitalization and persistence on assigned medication. Weight, laboratory tests, psychopathology, neurologic side effects, social adjustment and role functioning were assessed at 3–6 month intervals. Data were analyzed first by randomized treatment, and then reassessed controlling for prior medication treatment. The proportion of patients on assigned medication at 18 months was 30.9% for risperidone and 37.3% for olanzapine. Mean doses were 6.4+/−3.2 mg daily for risperidone, and 17.0+/−5.0mg daily for olanzapine. The groups did not differ significantly in time to medication discontinuation, first hospitalization or first employment. There were few differences in psychopathology, laboratory, or neurological assessments between groups at 18 months. Patients randomized to olanzapine gained modestly more weight. Controlling for pre-randomization medication suggested improvement in some aspects of psychopathology from switching medications; however, switching from olanzapine to risperidone was associated with more hospitalizations. Risperidone and olanzapine have similar efficacy and tolerability in patients with schizophrenia who are participating in supported employment. Randomization to olanzapine was associated with more weight gain, but randomization from olanzapine to risperidone appeared to be associated with a greater likelihood of hospitalization. Careful monitoring of metabolic effects and participation in supported employment may have contributed to minimal weight gain and metabolic effects.

Oral and long‐acting antipsychotics for relapse prevention in schizophrenia‐spectrum disorders: a network meta‐analysis of 92 randomized trials including 22,645 participants

“…After removing duplicates and examining titles and abstracts, we selected 514 records for full‐text assessment. Of these, 100 primary studies were eligible for inclusion (corresponding to 99 full‐text articles 57‐155 , as one paper reported on two trials). Of these, 92 studies, including 22,645 participants, provided data for ≥1 outcome of interest (see Figure 1).…”

Long‐term effectiveness of oral second‐generation antipsychotics in patients with schizophrenia and related disorders: a systematic review and meta‐analysis of direct head‐to‐head comparisons

“…Altogether, we included 63 reports (59 randomized studies) with 45,787 participants (median: 255 participants/study, range: from 12 to 18,154) (Table ). The mean age of the population was 37.6±7.0 years; 62.1±13.3% were male and 61.1±28.8% were white.…”

Real-world effectiveness of olanzapine and risperidone in the treatment of schizophrenia in Brazil over a 16-year follow-up period; findings and implications

“…Our finding reinforces the relevance of monitoring patients with schizophrenia over time and assessing the importance of a possible superiority of one antipsychotic over the other, except for the possible adverse events of each one. This hypothesis was verified in the study by Noordsy et al where olanzapine and risperidone showed similar efficacy among stable patients and in outpatient follow-up study, with no statistically significant differences between the causes for discontinuation of treatment [55]. In addition, there was also no significant difference between olanzapine and risperidone in some analyzes performed in the CATIE studies regarding all causes of discontinuation of treatment, including lack of effectiveness, in patients with schizophrenia [56,57].…”