New Antipsychotic Drugs No Better Than Older, Cheaper Medications

According to an emerging review, newer antipsychotic drugs are no better than older and cheaper schizophrenia medications.

Most of the adults in the United States—some 75 percent—are prescribed so-called second generation antipsychotics, said USNews. The newer drugs were developed with the hopes of patients experiencing less of the side effects that are seen in the older generation medications.

First-generation or typical antipsychotics are a drug class that includes Thorazine (chlorpromazine), Haldol (haloperidol), Etrafon and Trilafon (perphenazine), and Prolixin (fluphenazine). Second-generation or atypical antipsychotics include Risperdal (risperidone), Abilify (aripiprazole), Zyprexa (olanzapine), Seroquel (quetiapine fumarate), and Geodon (ziprasidone). There is a huge cost difference between first- and second- generation antipsychotics, notes USNews. For instance, a month’s supply of Zyprexa can cost about $546, while Haldol costs $18-$27 per month, according to Consumer Reports’ data.

Researchers at the U.S. Agency for Healthcare Research and Quality looked at 114 studies that involved a total of 22 comparisons between both drug classes to understand the differences. The research review appears in the August 14th issue of the journal, Annals of Internal Medicine. The team discovered that second-generation antipsychotics are no better at treating the positive symptoms of schizophrenia (hallucinations and delusions) than older generation medications. Negative symptoms involve decrease or normal function loss (expression or speech), explained USNews.

Longer-tem antipsychotic risks may include diabetes; major metabolic syndrome; and a neurological disorder that causes tardive dysinesia (involuntary, repetitive movements). “The typical antipsychotics that have been around for a long time are just as good at treating schizophrenia symptoms as the newer ones,” Dr. Dolores Malaspina, director of the Institute for Social and Psychiatric Initiatives at NYU Langone Medical Center in New York City, told USNews. She suggested that, in the future, doctors may create a personalized medicine approach to more effectively unite treatments with symptoms and disease manifestations. Until then, “my first choice would be to try one of the medications that have a longer track record, and then move on if need be.” She noted that the key differences between the two drug classes are side effects, said USNews.

“The newer drugs seem to be more effective with negative symptoms and, as such, they help with concentration and focus, but they cost a lot more and may have more metabolic side effects. It comes down to weighing the risks versus the benefit in each individual patient,” said Dr. David Straker, an adjunct assistant clinical professor of psychiatry at Columbia University Medical Center in New York City, who commented on the research. “The limitations of first-generation antipsychotics were well known prior to the introduction of second-generation antipsychotics, but now the metabolic issues and expense associated with using second-generation antipsychotics has created further challenges in the treatment of schizophrenia,” said Dr. Roberto Estrada, a psychiatrist at Lenox Hill Hospital in New York City. Estrada also noted that this review raises important concerns faced by those treating people with schizophrenia, said USNews.

We’ve long written about antipsychotic medications. According to a prior report, psychiatrists might not be fully aware of the issues surrounding these drugs. When eight atypical antipsychotics were presented to the U.S. Food & Drug Administration for approval—based on 24 studies—four were never published in professional journals and also presented the medication in less-than-flattering lights. In three of the unpublished studies, the new drug performed no better than a placebo, the fourth revealed that although the antipsychotic helped patients more than a placebo, older, cheaper drugs were of greater help to patients.

The analysis found that two of the unpublished studies found Abilify to be no more effective than a sugar pill for the schizophrenia treatment. The other two studies involved Geodon and one revealed that Geodon was no more effective than a placebo; the other found that while Geodon was more effective than a placebo, it was not as effective as the cheaper Haldol. Four published studies conducted on Fanapt (iloperidone) omitted unflattering data indicating that other drug choices worked better.

With this information left out of the professional journals on which the medical community often relies, psychiatrists do not have a full understanding of the true efficacy of atypical antipsychotics, noted The Washington Post. The phenomenon is known as publication bias, in which a new drug is presented in a positive light, while negative data is buried.