New anti-psychotic drugs no better than older, cheaper ones
November 2006Research led by the Division of Psychiatry has found that schizophrenia patients respond just as well - and perhaps even better - to older psychiatric drugs as newer, costlier alternatives.
According to the study, patients with schizophrenia whose medication is being changed gain little from being put on the newer drugs - despite their much larger market share. This runs contrary to the widely-held view that second-generation anti-psychotics are safer and more effective.
Antipsychotic medication is the main method of treating schizophrenia, with most UK patients currently receiving second-generation drugs. Previous trials suggested these were more effective and better tolerated than the first generation, leading most experts to recommend using them first despite their additional cost.
The NHS commissioned the study to assess whether these costs were off-set by improvements in patients’ quality of life or resort to health and social care services. “We thought that we would show the NHS that their misgivings were unfounded,” study leader Professor Shôn Lewis said.
However, after studying 227 schizophrenia patients who were randomly assigned to one class of drug or the other, the results failed to reveal the advantage in side effects or effectiveness predicted for the second generation drugs. Instead there was a trend towards the older drugs working better.
Shôn said: “We were so certain we would find exactly the opposite that we went back and checked the data. “But it all suggested that careful prescribing of first-generation anti-psychotics, at least in the context of a trial, is not associated with poorer efficacy or a greater adverse effect.
“A parallel trial did show that the second-generation drug clozapine improved quality of life and symptoms better than the other newer drugs,” he continued. “However, our research suggests that second-generation anti-psychotics are not the great breakthrough they were once thought to be – and certainly may not justify their ten-times-higher price tag.
“Further trials to evaluate both the role of second-generation anti-psychotics and the usefulness of cheaper, older drugs could save the NHS millions of pounds.”
