Older schizophrenia drugs cheaper and work just as well

Dec 4 2006

According to a new study an older antipsychotic drug has been found to be both cheaper and as effective for some patients with schizophrenia as the newer drugs on the market.

In a study funded by the National Institutes of Health in the U.S.A. the first generation antipsychotic drug perphenazine proved to be less expensive and just as effective as newer medications such as Seroquel (AstraZeneca) and Zyprexa (Eli Lilly).

The $42.6 million CATIE trial aimed to help doctors and the 2.4 million Americans who suffer from chronic schizophrenia find treatments to suit individual needs, is the first study to directly compare several second generation antipsychotic medications and with first generation drugs.

The study suggests doctors should consider the use of older antipsychotics as a first choice for patients with schizophrenia, which is one of a group of psychotic diseases characterised by delusions and hallucinations.

Dr. Jeffrey Lieberman, a psychiatrist at Columbia University Medical Center and the study's lead author, says the older drugs justify greater utilization from both a clinical and cost-effectiveness standpoint.

Currently almost all of the money spent on antipsychotic prescriptions is for second-generation drugs which can cost anything from $200 to $300 per month, and are double the cost of the older generic drugs.

Lieberman says doctors should not automatically exclude perphenazine and other older drugs from the range of options.

The second-generation antipsychotic drugs were introduced in the 1990s and of the $10 billion spent on then each year is mainly paid by the government.

Makers of the newer antipsychotic drugs are of course critical of the study and warn of the serious long-term side effects, such as tardive dyskinesia (TD), a movement disorder characterized by facial grimacing, tongue protrusion, rapid eye blinking and other involuntary motion associated with the older drugs.

But according to Lieberman the newer antipsychotic drugs are also associated with their own set of risks, including weight gain and an increased risk of diabetes.

The findings cast doubt on the notion that the second generation antipsychotics are better than the first generation antipsychotics, and suggests that perphenazine and other first generation antipsychotics may be just as beneficial for some patients.

Lieberman says he and his research colleagues hope policymakers will exercise restraint and not restrict the access and choice that patients and doctors have to antipsychotic drugs.

The study is published in the American Journal of Psychiatry on December 1, 2006.

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