First generation antipsychotic drugs may be viable option for schizophrenia
News release from the National Coordinating Centre for Health Technology Assessment
6 June 2006
Research commissioned by the NIHR Health Technology Assessment (HTA) programme suggests that older conventional drugs may still have a place in the treatment of patients with schizophrenia whose current drug treatment is proving ineffective. The findings of two clinical trials to compare the effectiveness of conventional drugs with the latest anti psychotic medication suggest that conventional drugs, which are substantially cheaper than new atypical drugs, are still an appropriate choice for patients whose medication is being changed due to inadequate clinical response or side effects. The research is published in the Health Technology Assessment journal Vol 10.17 this week (06 June) http://www.hta.ac.uk/project/1078.asp
Led by Professor Shon Lewis, Professor of Adult Psychiatry at the University of Manchester, the study featured two clinical trials involving more than 300 participants at adult mental health centres within 14 NHS trusts in Greater Manchester, Nottingham, Cambridge and London. The aim of the study was to compare the effectiveness and cost-effectiveness of different classes of antipsychotic drugs in people with treatment resistant schizophrenia, to establish whether new atypical agents outperform conventional antipsychotic agents in such patients.
"While conventional drugs are effective in 70 per cent of patients, they are associated with frequent neurological side effects," says Professor Lewis. "Newer drugs have a lower risk of side effects and, in the case of the drug clozapine, better efficacy. However the cost of these new drugs is significantly more than conventional drugs so it is essential that cost and clinical efficiency comparisons are made in real life NHS settings."
The first trial aimed to establish whether, in patients whose schizophrenia symptoms have proved resistant to treatment with one of the newer atypical drugs, use of a conventional antipsychotic drug or another atypical drug would be most effective and cost effective. In the second trial, the new atypical drugs were compared with clozapine to establish whether the additional costs of clozapine would be offset by improvements in quality of life for more severely treatment resistant patients, and or savings in the use of other services.
The research team concluded that, independent of the group of drugs the patient appeared to be resistant to, there was no disadvantage in terms of quality of life, symptoms, or associated costs of care over one year in changing to a different conventional antipsychotic drug rather than a different new atypical drug. In fact conventional drugs were associated with (non-significantly) better outcomes and lower costs. Net costs to the NHS of mental health care over one year averaged £18850 in the conventional drug group, and £20123 in the new atypical group, not a significant difference. Of these costs, the cost of the drugs themselves was less than 5% in each group.
The second trial, which compared the new atypical dugs with clozapine, found that clozapine showed advantages in terms of quality of life and symptoms, and it also had less side effects. Participants reported at 12 weeks that their mental health was significantly better with clozapine than with new atypicals. The average cost of patient care with clozapine was £33800 compared to £28400.
"The results of the study suggest that conventional drugs may still have a place in the treatment of patients unresponsive to or intolerant of their current medication," says Professor Lewis.
Notes:
The atypical drugs featured in the trial were risperidone, olanzapine, quetiapine and amisulpride and the conventional drugs were chlorpromazine, haloperidol, thioridazine, sulpiride, depot medications.
Notes for editors
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The HTA programme is a programme of the National Institute for Health Research (NIHR) and produces high quality research information about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS. It is the largest of the NIHR programmes and publishes the results of its research in the Health Technology Assessment journal, with more than 400 issues published to date. The journal’s 2007 Impact Factor (3.87) ranked it in the top 10% of medical and health-related journals. All issues are available for download free of charge from the website, www.hta.ac.uk The HTA programme is coordinated by the National Coordinating Centre for Health Technology Assessment (NCCHTA), based at the University of Southampton.
- The National Institute for Health Research provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility. The NIHR provides the NHS with the support and infrastructure it needs to conduct first-class research funded by the Government and its partners alongside high-quality patient care, education and training. Its aim is to support outstanding individuals (both leaders and collaborators), working in world class facilities (both NHS and university), conducting leading edge research focused on the needs of patients. www.nihr.ac.uk
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