Haloperidol plus benztropine are as effective against schizophrenia as olanzapine and provide a comparable quality of life, yet are far less expensive, according to an article in the November 26th issue of the Journal of the American Medical Association. The authors write that the American study, which involved 17 hospitals for military veterans, is the first long-term study to compare drug effectiveness, safety, and resultant quality of life among people with schizophrenia

“We gave the benztropine prophylactically along with the haloperidol, as is needed for a fair and clinically informative comparison,” said lead author Robert Rosenheck, M.D. “That’s why we think this study is more relevant to everyday practice. We wanted to compare the 2 drugs in the way they are used in the real world.”

The randomized, double-blinded study, which followed patients for 1 year, found no differences between the drugs in reducing symptoms of schizophrenia symptoms or improving quality of life. In terms of side effects, olanzapine tended to cause weight gain. It was also associated with slightly less akithisia and somewhat better cognitive status, but not enough to improve patients’ quality of life or overall function. Olanzapine use was not associated with significant reductions in in-hospital or outpatient costs.

Rosenheck said he does not see the study as prompting a return to the older class of antipsychotic drugs. The newer atypical antipsychotics have become widely accepted over the past 10 years as the first-line choice for treating schizophrenia. However, he said that the findings sharply challenge the perception that olanzapine, although costlier at the pharmacy, more than pays for itself by lowering overall health-care and social service costs for its users. In the study, olanzapine was associated with $3,000 to $9,000 more in greater annual costs per patient, with most of that due to the difference in cost for the medication itself.

“This study suggests that the advantages of olanzapine may be limited, while costs are considerably greater,” said Rosenheck. “As a nation we are spending $2 billion annually on a treatment whose advantage over less expensive treatments is questionable and which may incur adverse health effects related to weight gain.”

Current guidelines in the government hospital system recommend use of either risperidone or quetiapine as first-line choices for schizophrenia. Olanzapine, along with ziprasidone and clozapine, is a second-line drug. Typical antipsychotic drugs such as haloperidol are only recommended when patients fail to respond to the above treatments.

Rosenheck said his team wants to pursue studies analyzing the benefits of a new long-acting, injectable form of risperidone that may result in better compliance. In additional research, 4 hospitals in the system are among 53 U.S. sites currently participating in a $42-milllion nationwide study comparing 5 atypical antipsychotic drugs with each other and with an older, traditional antipsychotic drug.