Quetiapine and risperidone show equivalent efficacy for schizophrenia but quetiapine appears to be associated with a lesser degree of extrapyramidal symptoms

Quetiapine and risperidone have equivalent efficacy for patients with schizophrenia exhibiting predominately negative symptoms, but quetiapine has superior tolerability, especially with respect to extrapyramidal symptoms, according to an article in the January issue of the European Archives of Psychiatry and Clinical Neuroscience.

The current study was a double-blind, randomized study comparing efficacy and tolerability of the two atypical antipsychotics.

The study investigator, Michael Riedel, MD, Ludwig-Maximilian-University Munich, Germany, commented: "One of the key issues in treating patients with schizophrenia is achieving a good quality of life by balancing efficacy and tolerability of medication. Negative symptoms associated with schizophrenia are less responsive to treatment. This small, but tightly controlled pilot study shows that quetiapine and risperidone have the same efficacy in patients with schizophrenia exhibiting mainly negative symptoms, but only quetiapine shows a statistically significant effect on treating alogia and affective blunting compared to baseline.

“Importantly there are significant differences in the tolerability between both medications; quetiapine was superior in many tolerability parameters including extrapyramidal symptoms. To patients, a reduction in extrapyramidal symptoms really matters in terms of quality of life. Medication with less extrapyramidal symptoms therefore may help address patient compliance issues by achieving the best balance of treatment efficacy and superior tolerability."

A total of 44 patients with schizophrenia presenting with predominantly negative symptoms were randomized to quetiapine (mean dose 589.7 mg/day) or risperidone (mean dose 4.9 mg/day) for a 12-week study period.

Efficacy was measured by the Positive and Negative Syndrome Scale (PANSS) score (primary endpoint) and the Scale for the Assessment of Negative Symptoms (SANS) and Clinical Global Impression (CGI) rating scale. Tolerability was measured using the Simpson-Angus Scale (SAS) and various laboratory measurements Patients in both treatment groups showed significant improvements in the PANSS (Positive and Negative Syndrome Scale) total, positive, negative, and general psychopathology scores (P<0.01 compared to baseline).

Patients in both treatment groups experienced significant reduction in negative symptoms as early as week one (P less than or equal to 0.01) and this improvement continued up to week 12 (P less than or equal to 0.01 for all time points).

At week 12, both medications also achieved significant improvements on some parameters of the Assessment of Negative Symptoms (SANS) scale (quetiapine P<0.001 and risperidone P<0.01 compared to baseline); however only quetiapine demonstrated significant improvements in alogia and affective blunting compared to baseline (both P<0.001).

Patients treated with quetiapine had a significantly lower incidence of extrapyramidal symptoms, including akathisia and parkinsonism compared to patients treated with risperidone (P=0.006). In addition, more patients using risperidone required anticholinergic medication to control such symptoms.
Quetiapine also resulted in decreased serum prolactin levels, while risperidone increased prolactin levels, which has frequently been associated with reduction in sexual drive and fertility.

 

 


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