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Effectiveness of second-generation antipsychotics: a naturalistic, randomized comparison of olanzapine, quetiapine, risperidone, and ziprasidone.
BMC Psychiatry. 2010 Mar 24; 10:26.BP

Abstract

BACKGROUND

No clear recommendations exist regarding which antipsychotic drug should be prescribed first for a patient suffering from psychosis. The primary aims of this naturalistic study were to assess the head-to-head effectiveness of first-line second-generation antipsychotics with regards to time until drug discontinuation, duration of index admission, time until readmission, change of psychopathology scores and tolerability outcomes.

METHODS

Patients >or= 18 years of age admitted to the emergency ward for symptoms of psychosis were consecutively randomized to risperidone (n = 53), olanzapine (n = 52), quetiapine (n = 50), or ziprasidone (n = 58), and followed for up to 2 years.

RESULTS

A total of 213 patients were included, of which 68% were males. The sample represented a diverse population suffering from psychosis. At admittance the mean Positive and Negative Syndrome Scale (PANSS) total score was 74 points and 44% were antipsychotic drug naïve. The primary intention-to-treat analyses revealed no substantial differences between the drugs regarding the times until discontinuation of initial drug, until discharge from index admission, or until readmission. Quetiapine was superior to risperidone and olanzapine in reducing the PANSS total score and the positive subscore. Quetiapine was superior to the other drugs in decreasing the PANSS general psychopathology subscore; in decreasing the Clinical Global Impression - Severity of Illness scale score (CGI-S); and in increasing the Global Assessment of Functioning - Split version, Functions scale score (GAF-F). Ziprasidone was superior to risperidone in decreasing the PANSS positive symptoms subscore and the CGI-S score, and in increasing the GAF-F score. The drugs performed equally with regards to most tolerability outcomes except a higher increase of hip-circumference per day for olanzapine compared to risperidone, and more galactorrhoea for risperidone compared to the other groups.

CONCLUSIONS

Quetiapine appears to be a good starting drug candidate in this sample of patients admitted to hospital for symptoms of psychosis.

TRIAL REGISTRATION

ClinicalTrials.gov ID; URL: http://www.clinicaltrials.gov/: NCT00932529.

Authors+Show Affiliations

Division of Psychiatry, H aukeland University Hospital, Sandviken, Pb 23, N-5812 Bergen, Norway. erij@ihelse.netNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20334680

Citation

Johnsen, Erik, et al. "Effectiveness of Second-generation Antipsychotics: a Naturalistic, Randomized Comparison of Olanzapine, Quetiapine, Risperidone, and Ziprasidone." BMC Psychiatry, vol. 10, 2010, p. 26.
Johnsen E, Kroken RA, Wentzel-Larsen T, et al. Effectiveness of second-generation antipsychotics: a naturalistic, randomized comparison of olanzapine, quetiapine, risperidone, and ziprasidone. BMC Psychiatry. 2010;10:26.
Johnsen, E., Kroken, R. A., Wentzel-Larsen, T., & Jørgensen, H. A. (2010). Effectiveness of second-generation antipsychotics: a naturalistic, randomized comparison of olanzapine, quetiapine, risperidone, and ziprasidone. BMC Psychiatry, 10, 26. https://doi.org/10.1186/1471-244X-10-26
Johnsen E, et al. Effectiveness of Second-generation Antipsychotics: a Naturalistic, Randomized Comparison of Olanzapine, Quetiapine, Risperidone, and Ziprasidone. BMC Psychiatry. 2010 Mar 24;10:26. PubMed PMID: 20334680.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effectiveness of second-generation antipsychotics: a naturalistic, randomized comparison of olanzapine, quetiapine, risperidone, and ziprasidone. AU - Johnsen,Erik, AU - Kroken,Rune A, AU - Wentzel-Larsen,Tore, AU - Jørgensen,Hugo A, Y1 - 2010/03/24/ PY - 2009/06/24/received PY - 2010/03/24/accepted PY - 2010/3/26/entrez PY - 2010/3/26/pubmed PY - 2010/5/7/medline SP - 26 EP - 26 JF - BMC psychiatry JO - BMC Psychiatry VL - 10 N2 - BACKGROUND: No clear recommendations exist regarding which antipsychotic drug should be prescribed first for a patient suffering from psychosis. The primary aims of this naturalistic study were to assess the head-to-head effectiveness of first-line second-generation antipsychotics with regards to time until drug discontinuation, duration of index admission, time until readmission, change of psychopathology scores and tolerability outcomes. METHODS: Patients >or= 18 years of age admitted to the emergency ward for symptoms of psychosis were consecutively randomized to risperidone (n = 53), olanzapine (n = 52), quetiapine (n = 50), or ziprasidone (n = 58), and followed for up to 2 years. RESULTS: A total of 213 patients were included, of which 68% were males. The sample represented a diverse population suffering from psychosis. At admittance the mean Positive and Negative Syndrome Scale (PANSS) total score was 74 points and 44% were antipsychotic drug naïve. The primary intention-to-treat analyses revealed no substantial differences between the drugs regarding the times until discontinuation of initial drug, until discharge from index admission, or until readmission. Quetiapine was superior to risperidone and olanzapine in reducing the PANSS total score and the positive subscore. Quetiapine was superior to the other drugs in decreasing the PANSS general psychopathology subscore; in decreasing the Clinical Global Impression - Severity of Illness scale score (CGI-S); and in increasing the Global Assessment of Functioning - Split version, Functions scale score (GAF-F). Ziprasidone was superior to risperidone in decreasing the PANSS positive symptoms subscore and the CGI-S score, and in increasing the GAF-F score. The drugs performed equally with regards to most tolerability outcomes except a higher increase of hip-circumference per day for olanzapine compared to risperidone, and more galactorrhoea for risperidone compared to the other groups. CONCLUSIONS: Quetiapine appears to be a good starting drug candidate in this sample of patients admitted to hospital for symptoms of psychosis. TRIAL REGISTRATION: ClinicalTrials.gov ID; URL: http://www.clinicaltrials.gov/: NCT00932529. SN - 1471-244X UR - https://www.unboundmedicine.com/medline/citation/20334680/Effectiveness_of_second_generation_antipsychotics:_a_naturalistic_randomized_comparison_of_olanzapine_quetiapine_risperidone_and_ziprasidone_ L2 - https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-10-26 DB - PRIME DP - Unbound Medicine ER -