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Newer drugs aren't any better at treating a first episode of schizophrenia than the older drug haloperidol, according to a new study. Even so, more patients seem to prefer the newer drugs, researchers say.


Researchers randomly assigned 498 patients with schizophrenia or schizophreniform disorder to use either haloperidol or a second-generation drug such as amisulpride, olanzapine, quetiapine, or ziprasidone. Regardless of which drug they took, 60% of patients experienced a reduction in symptoms, and researchers found no significant differences in adverse reactions or behaviors such as drug abuse or suicidal behavior. But during the year following the start of taking the drugs, 63 patients stopped taking haloperidol, compared with:


* 32 who stopped taking amisulpride


* 30 who stopped taking olanzapine


* 51 who stopped taking quetiapine


* 31 who stopped taking ziprasidone.



The researchers concluded that effective treatment of schizophrenia for at least 1 year is achievable, but that second-generation drugs aren't necessarily any more effective than haloperidol.


Patients and physicians participating in the study weren't blinded to the assigned treatment. In commentary accompanying the published study, an expert speculated that physician's enthusiasm for newer drugs may have influenced the results. He calls for an objective double-blinded trial to get a clearer picture of patients' preferences.




Kahn RS, et al., Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: An open randomized clinical trial, The Lancet, March 29, 2008; Rosenheck RA, Pharmacotherapy of first-episode schizophrenia, The Lancet, March 29, 2008.