Efficacy Comparison Common Side Effects of Antipsychotics Hyperprolactinemia Antipsychotic Weight Gain Interventions for Weight Gain Diabetes Reference

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Professional Issues >> Total Wellness Efficacy Compared Between Two Atypical Antipsychotic Agents When Tran et al.1 compared olanzapine with risperidone in patients with schizophrenia, significant (p < .001) within-group improvement from baseline to endpoint was seen in both groups on rating scale measures. But olanzapine demonstrated significantly (p = .020) greater efficacy for negative symptoms, based on the Scale for Assessment of Negative Symptoms (SANS) summary score. SANS measures showed olanzapine to be significantly superior to risperidone for affect, avolition, and anhedonia (Table A). The results of these SANS measures are consistent with the greater improvement found in the Positive and Negative Syndrome Scale (PANSS) depression item scores among olanzapine patients than among risperidone patients. Olanzapine patients' mean change in the PANSS depression item score was significantly greater than that of risperidone patients (p = .004) (Table B). Negative Symptoms SANS Measures OLZ > RIS Affect Avolition Anhedonia Alogia Attention Affect (p = .011) Avolition (p = .015) Anhedonia (p = .003) Table A. Data from Tran et al.1 Abbreviations: SANS = Scale for Assessment of Negative Symptoms, OLZ = olanzapine, RIS = risperidone PANSS Depression Item   Baseline Mean ± SD OLZ 3.0 ± 1.2 RIS 2.9 ±1.3   Change Mean ± SD OLZ -1.1 ± 1.3 RIS -0.7± 1.4 Table B. Data from Tran et al.1 Abbreviations: SANS = Scale for assessment of Negative Symptoms, OLZ = olanzapine, RIS = risperidone Percentages of Patients Taking Two Atypical Antipsychotics Who Maintained Acute Response at Week 28 After a patient with schizophrenia has responded to medication, relapse prevention becomes part of maintaining the patient's overall well-being, and reintegration into the community becomes a major goal. Tran et al.1 measured the percentages of patients who had maintained their acute response at weeks 12 and 28. Significant symptom exacerbation was defined as a 20% or greater worsening in Positive and Negative Syndrome Scale (PANSS) total score and Clinical Global Impression-Severity of Illness (CGI-S) score. The figure demonstrates that an estimated 98% of patients taking olanzapine had maintained their acute response at week 12, and an estimated 88% had done so at week 28. Of patients taking risperidone, 91% maintained their acute response at week 12, and 68% did so at week 28. Safety of Two Atypical Antipsychotics Compared in Double-Blind Study In the Tran et al.1 comparison of olanzapine and risperidone, there were more spontaneously reported and solicited adverse events among risperidone-treated patients than among those taking olanzapine. Nine side effects were spontaneously reported significantly more frequently by the risperidone group than by those taking olanzapine(Table A). Only weight gain was reported significantly more frequently by olanzapine-treated patients. However, mean weight change from baseline to endpoint was significant within both treatment groups. Olanzapine-treated patients gained 4.1 + 5.9 kg, and risperidone-treated patients gained 2.3 + 4.8 kg. Among the solicited treatment-emergent adverse events, 6 events were found in a significantly greater proportion of risperidone-treated patients than olanzapine-treated patients (Table B). No solicited treatment-emergent adverse events were found in a significantly larger proportion of olanzapine-treated patients. Adverse Events Spontaneously Reported Significantly More Often Risperidone Group Olanzapine Group Nausea Amblyopia Extrapyramidal symptoms (EPS) Increased salivation Suicide attempts Abnormal ejaculation Back pain Increase in creatine phosphokinase Urinary tract infection Weight gain Table A. Data from Tran et al.1   Solicited Adverse Events Found Significantly More Often Risperidone Group Olanzapine Group Early waking Blurred vision Backache Breathing difficulties Delayed ejaculation Increased dreams/nightmares (NONE) Table B. Data from Tran et al.1

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