Dispute Over Schizophrenia Drugs

Older schizophrenia drugs may be as effective as the new generation of medications, experts have suggested. A Manchester University study shows patients respond just as well, and perhaps better, to the older ones. The Archives of General Psychiatry findings run contrary to the widely held view that newer and dearer drugs are safer and more effective. But critics say the newer drugs are better and preferred by patients because they have fewer side effects.

The new UK results back similar work by US investigators who recently suggested it might be better to switch back to prescribing the older drugs to cut healthcare costs. The NHS funded the latest work to assess whether the bigger price tag of newer “atypical” antipsychotics was offset by improvements in patients’ quality of life or reductions in the use of health and social care services.

Atypical antipsychotics, which include risperidone, quetiapine, clozapine and olanzapine, cost at least 10 times more than their predecessors.

The Manchester team, along with colleagues from the University of Cambridge, Institute of Psychiatry and Imperial College London, studied 227 schizophrenia patients for whom a change in drug treatment was being considered because of ineffectiveness or harmful side effects.

Experienced doctors decided which type of antipsychotic – newer or older – would be best for each patient. The patients were assessed before and 12, 26 and 52 weeks after their drugs were switched, using measurements of quality of life, symptoms, side effects, and satisfaction with the drug. Overall, the newer atypical drugs showed no advantage in side effects or effectiveness.

Lead researcher Professor Shôn Lewis suggested further trials to evaluate the usefulness of cheaper, older drugs could potentially save the NHS millions of pounds. He said: “Despite modern prescribing patterns, second-generation anti-psychotics are not the great breakthrough they were once thought to be – and certainly may not justify their 10-times higher price tag.”

A parallel trial, also funded by the NHS, did confirm previous reports that one newer antipsychotic called clozapine stood out from the other atypicals for treating severe schizophrenia.

Jo Loughran, of the mental health charity Rethink, said both types of drugs old and new could bring different benefits and side effects for different people. She said: “Atypical antipsychotic medicines should always be considered in the first-line treatment of schizophrenia, and patients should be offered an informed choice of medicines to suit them.”

The government’s drugs watchdog NICE echoes this advice. However, it also says people with schizophrenia who are already taking an older antipsychotic which is working for them should not switch to a newer drug.

Marjorie Wallace, chief executive of the mental health charity SANE, warned it would be wrong to limit accessibility to news anti-psychotics. “What we hope is that the study will flag up the importance of patients being able to look at the risks and benefits of different drugs, matched to their own biochemistry, and that it will encourage the pharmaceutical companies in their current research to develop third-generation medications.”