A comparative effectiveness study of risperidone and olanzapine in the treatment of schizophrenia.
A comparative effectiveness study of risperidone and olanzapine in the treatment of schizophrenia.
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DOI：
10.4088/jcp.v60n1003
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发表时间：
1999-10
期刊：
影响因子：
--
通讯作者：
B. Ho;Del D. Miller;P. Nopoulos;N. Andreasen
中科院分区：
文献类型：
--
作者：
B. Ho;Del D. Miller;P. Nopoulos;N. Andreasen
背景：利培酮和奥氮平分别被证明是治疗慢性精神分裂症的有效和安全的药物。为了评估它们的相对有效性，并更好地了解每种抗精神病药物在实际临床使用中的优势和局限性，我们将一种药物直接与另一种药物进行比较。方法42例DSM-IV精神分裂症患者接受利培酮或奥氮平开放治疗。比较组内和组间急性治疗前后的症状、全球功能和锥体外系副作用。在6个月的随访中，进一步评估这两种非典型抗精神病药物对症状和生活质量的相对疗效。结果经过平均4周的急性治疗，利培酮和奥氮平均能有效地减轻阴性症状、精神病性症状和紊乱症状。虽然这两种抗精神病药都与治疗后帕金森病的低发生率有关，但利培酮更有可能导致静坐不能。即使考虑到利培酮组中较高的抗胆碱能使用率，治疗帕金森综合症的措施在不同的治疗组中也没有不同。在这两种非典型抗精神病药物治疗6个月后，服用利培酮的受试者的精神症状有了显著的减少。此外，利培酮和奥氮平在减少混乱和阴性症状以及提高生活质量方面似乎同样有效。结论利培酮与奥氮平治疗急性期脑出血疗效相同。利培酮在6个月时对精神症状的治疗效果更好，但在精神分裂症患者的常规临床护理中，两种药物的疗效相同。如果使用低剂量(每天6毫克)的利培酮，这两种药物的帕金森副作用发生率相当。
BACKGROUND Risperidone and olanzapine have each been demonstrated to be efficacious and safe in the treatment of patients with chronic schizophrenia. To evaluate their relative effectiveness, and to better understand the advantages and limitations of each neuroleptic during actual clinical use, we compared one directly against the other. METHOD Forty-two subjects with DSM-IV schizophrenia had received open-label treatment with either risperidone or olanzapine. Symptoms, global functioning, and extrapyramidal side effects before and after acute treatment were compared within and across groups. At 6-month follow-up, the relative effectiveness of these 2 atypical neuroleptics on symptoms and quality of life were further evaluated. RESULTS Following an average of 4 weeks of acute treatment, both risperidone and olanzapine were effective in reducing negative, psychotic, and disorganized symptoms. Although both neuroleptics were associated with low occurrence of treatment-emergent parkinsonism, risperidone was more likely to induce akathisia. The measures for parkinsonism were no different across treatment groups, even after taking into account the higher rate of anticholinergic use in the risperidone group. Following 6 months of treatment with these 2 atypical neuroleptics, there was a significantly greater reduction in psychotic symptoms among risperidone-treated subjects. Otherwise, risperidone and olanzapine appear to be equally effective in reducing disorganized and negative symptoms and in improving the quality of life. CONCLUSION Risperidone and olanzapine were equally effective as acute treatments. Risperidone was more effective for treatment of psychotic symptoms at 6 months, but otherwise the 2 medications were equally effective in the routine clinical care of patients with schizophrenia. If low (<6 mg/day) doses of risperidone are used, the 2 medications have comparable rates of parkinsonian side effects.