Report on drugs for Schizophrenia

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An interesting article. You may have to register to see the entire report.

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Schizophrenia Drugs Comparable, Study Shows
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An older, cheaper medication is as effective as most newer ones. But
all display drawbacks.

By Rosie Mestel
Times Staff Writer

September 20 2005

A study comparing schizophrenia drugs has found that an older
medication, perphenazine, is as effective at managing the devastating brain
disorder as most of the newer, more expensive drugs.

The complete article can be viewed at:
www.latimes.com/news/science/la-sci-schizophrenia20sep20,0,4410786.story

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A further report From the NEW YORK TIMES:

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September 20, 2005
Little Difference Found in Schizophrenia Drugs
By BENEDICT CAREY
A landmark government-financed study that compared
drugs used to treat schizophrenia has confirmed what
many psychiatrists long suspected: newer drugs that
are highly promoted and widely prescribed offer few -
if any - benefits over older medicines that sell for a
fraction of the cost.

The study, which looked at four new-generation drugs,
called atypical antipsychotics, and one older drug,
found that all five blunted the symptoms of
schizophrenia, a disabling disorder that affects three
million Americans. But almost three-quarters of the
patients who participated stopped taking the drugs
they were on because of discomfort or specific side
effects.

One of the newer drugs, Zyprexa, from Eli Lilly,
helped more patients control symptoms for
significantly longer than the other drugs. But Zyprexa
also had a higher risk of serious side effects - like
weight gain - that increase the risk of diabetes.

The study, released yesterday and to be published
Thursday in The New England Journal of Medicine, was
widely anticipated because it is by far the largest,
most rigorous head-to-head trial of the newer
antipsychotics conducted without significant drug
industry financing. The new drugs account for $10
billion in annual sales and 90 percent of the national
market for antipsychotics.

The findings may not significantly alter the
prescribing patterns of doctors in private practice,
who often do not have to worry about cost,
psychiatrists said. But they are likely to have an
enormous effect on state Medicaid programs, many short
on funds in part because of the high cost of
schizophrenia drugs.

Several states, including Kentucky, West Virginia and
Maine, have limited access to newer drugs, which cost
3 times to 10 times more than the older drugs. "The
new study presents an opportunity but also a risk,"
said John Goodman, president of the National Center
for Policy Analysis, a policy research group based in
Dallas, which estimates that Medicaid programs spend
at least $3 billion a year on antipsychotics, more
than for any other drug class.

"The opportunity is to lower the cost of these drugs,"
Dr. Goodman said. "The risk is that state Medicaid
programs use this excuse to entirely deny some
patients access to more effective and more expensive
drugs which work for those patients."

The government study set out to judge each drug by how
long patients and their doctors continued the therapy,
a criterion rarely used in studies by drug makers but
crucial in real-world practice. People with
schizophrenia struggle with delusional thoughts,
private voices, blunted emotions and other symptoms,
and most try multiple drugs in trying to avoid severe
side effects.

The researchers, led by psychiatrist Dr. Jeffrey
Lieberman, then at the University of North Carolina
and now at Columbia University, recruited 1,493 people
with the disorder and assigned them to receive one of
five drugs: Risperdal, from Johnson & Johnson;
Seroquel from AstraZeneca; Geodon from Pfizer;
Zyprexa; and an older drug,perphenazine.

After 18 months, the researchers found, 64 percent of
the patients taking Zyprexa had stopped, and at least
74 percent had quit each of the other medications. The
most common reasons were that the drug was not
effective, the patient could not tolerate taking it,
side effects like sleepiness and weight gain or
neurological symptoms like stiffness or tremors.

Doctors' concerns about neurological side effects in
particular have sped the switch to newer schizophrenia
drugs over the last decade. Studies have shown that
these medications carry a lower risk than the older
drugs of tardive dyskinesia, a disorder that causes
tics, lip-smacking and other involuntary movements.

But the study found that at more modest doses, the
older drug, perphenazine, while just as effective, was
not significantly more likely to cause neurological
symptoms. Dr. Lieberman said that there was no reason
to believe that modest doses of other older drugs,
like Haldol, would perform differently.

The patients on Zyprexa were less likely to be
hospitalized because their condition worsened than
those taking the other drugs, the study found. But
these patients also gained the most weight, adding an
average of two pounds a month while on the drug, and
their lipid levels increased more than those of people
on the other drugs. Weight gain and elevated lipids
are risk factors for diabetes.

In the doses used in the study, a month's supply of
perphenazine costs about $60, compared with $520 for
Zyprexa, $450 for Seroquel, $250 for Risperdal and
$290 for Geodon, according to Drugstore.com.

"Probably the biggest surprise of all was that the
older medication produced about as good an effect as
the newer medications, three of them anyway, and did
not produce neurological side effects at greater rates
than any of the other drugs," said Dr. Lieberman in an
interview.

Dr. Robert Baker, who directs the neuroscience group
at Eli Lilly, said that he was pleased with the
findings. He said the weight gain and other side
effects of Zyprexa were "very consistent with what
we've seen in our studies" and that the company tells
doctors about these symptoms.

"I think what we can conclude from this study is that
there is no one-size-fits-all treatment for
schizophrenia," Dr. Baker said.

Spokesmen for Johnson & Johnson and AstraZeneca said
that the study supported their drugs and the
importance of tailoring treatment to individual
patients. "The efficacy results for Risperdal did not
demonstrate the full efficacy of Risperdal because
many patients in the trial received doses that were
too low," Dr. Ramy Mahmoud, of Janssen Pharmaceutica,
the unit of Johnson & Johnson that makes Risperdal,
said in an e-mail message.

One thing that all agreed on was that the current
state of schizophrenia treatment leaves a lot to be
desired, and that the field longs for new and
different drugs.

"The message is the glass is half full," Dr. Lieberman
said. "The drugs work but they are not satisfactory to
many patients, and three-quarters of the people in our
study voted with their feet and discontinued the
drugs."

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