Olanzapine and haloperidol in first episode psychosis: Two-year data

Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
Schizophrenia Research (Impact Factor: 3.92). 09/2006; 86(1-3):234-43. DOI: 10.1016/j.schres.2006.06.021
Source: PubMed


Few studies have assessed the comparative efficacy and safety of atypical and typical antipsychotic medications in patients within their first episode of psychosis. This study examined the effectiveness of the atypical antipsychotic olanzapine and the typical antipsychotic haloperidol in patients experiencing their first episode of a schizophrenia-related psychotic disorder over a 2-year treatment period. Two hundred and sixty-three patients were randomized to olanzapine or haloperidol in a doubleblind, multisite, international 2-year study. Clinical symptoms and side effects were assessed at baseline and longitudinally following randomization for the duration of the study. Olanzapine and haloperidol treatment were both associated with substantial and comparable reductions in symptom severity (the primary outcome measure) over the course of the study. However, the treatment groups differed on two secondary efficacy measures. Patients were less likely to discontinue treatment with olanzapine than with haloperidol: mean time (in days) in the study was significantly greater for those treated with olanzapine compared to haloperidol (322.09 vs. 230.38, p<0.0085). Moreover, remission rates were greater in patients treated with olanzapine as compared to those treated with haloperidol (57.25% vs. 43.94%, p<0.036). While extrapyramidal side effects were greater in those treated with haloperidol, weight gain, cholesterol level and liver function values were greater in patients treated with olanzapine. The data from this study suggest some clinical benefits for olanzapine as compared to haloperidol in first episode patients, which must be weighed against those adverse effects that are more likely with olanzapine.

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    • "Remission was the primary outcome in their double-blind randomized trial comparing chlorpromazine to clozapine in fi rstepisode psychosis patients that were antipsychoticna ï ve. They found remission rates of approximately 80% for both antipsychotics at the 1-year follow-up, whereas another double-blind randomized controlled trial of olanzapine versus haloperidol found remission rates of only 57.25% for olanzapine and 43.94% for haloperidol after 2 years (Green et al., 2006). Their defi nition of remission was mild or less positive psychotic symptoms (P1, 2, 3, 5 and 6 on the PANSS) and a CGI of 3 or less for 4 weeks consecutively. "
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    ABSTRACT: Abstract Early intervention services are based on the premise that untreated psychosis may have a deleterious effect on outcome, particularly in the early years of illness. The majority of the studies on duration of untreated psychosis have been conducted in developed countries; therefore this review focuses on publications from developing countries. We also review studies from developing countries that have been published following the Remission in Schizophrenia Working Group criteria. The duration of untreated psychosis is longer in developing countries, and is also associated with poor outcome, whereas remission rates following treatment of first-episode schizophrenia in developing countries appear to be higher than in developed countries. These two findings strongly argue for the establishment of early intervention services for schizophrenia in developing countries.
    International Review of Psychiatry 10/2012; 24(5):483-8. DOI:10.3109/09540261.2012.704873 · 1.80 Impact Factor
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    • "At 12 weeks, olanzapine but not haloperidol, was associated with a reduced response with regard to their psychotic symptomatology in those abusing alcohol compared with those not abusing alcohol. No data regarding substance use at the 2 year end point was reported (Green et al., 2006). In other small trials, no clinically meaningful differences were found, (Sayers et al., 2005; Smelson et al., 2006) (Ib). "
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    Journal of Psychopharmacology 05/2012; 26(7):899-952. DOI:10.1177/0269881112444324 · 3.59 Impact Factor
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    • "Haloperidol, risperidone, olanzapine and quetiapine were the only drugs assessed in more than one trial (Figure 1). In terms of FGAs, seven trials assessed haloperidol (Crespo-Facorro et al., 2006, 2011; Emsley 1999; Gaebel et al., 2007; Green et al., 2006; Kahn et al., 2008; Lieberman et al., 2003b; Möller et al., 2008; Sanger et al., 1999; Schooler et al., 2005), one assessed zuclopenthixol (Glenthoj et al., 2007) and one assessed chlorpromazine (Lieberman et al, 2003a). "
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    ABSTRACT: This systematic review aimed to determine whether the risk of extrapyramidal side effects (EPS) differed between antipsychotic drugs used in first episode psychosis (FEP). We identified 11 RCTs comparing two or more antipsychotics in FEP and reporting on EPS. All trials assessed one or more second generation antipsychotics (SGAs), one assessed chlorpromazine, one zuclopenthixol and seven trials assessed haloperidol. Assessment and reporting of EPS varied. Compared with one or more SGA comparators, haloperidol was associated with significantly higher rates/severity of parkinsonism (seven trials) and akathisia (six trials) and greater use of anticholinergics (five trials) and beta-blockers (two trials). Two trials with low-dose haloperidol (≤ 4 mg) showed significantly worse EPS outcomes versus a SGA. Two of four long-term haloperidol trials (≥ 1 year) found a higher dyskinesia-risk with haloperidol versus olanzapine and risperidone respectively; the remaining two trials found no difference (various SGA comparators). There was an EPS advantage for clozapine versus chlorpromazine (one trial) and risperidone versus zuclopenthixol (one trial). There was little evidence of EPS-differences between SGAs, possibly reflecting use of low doses. We conclude that SGAs offer an EPS advantage over FGAs in FEP though the evidence largely relates to comparisons with haloperidol. Standardized assessment and reporting of EPS would assist future research.
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