Newer Schizophrenia Drugs More
Expensive And No Better Than Older Ones

The first direct comparison of five schizophrenia drugs found that most newer treatments are no better than an older generic drug, despite their higher cost, a recent study released showed.

The lone exception, Eli Lilly and Co.'s Zyprexa, may be better than the other medicines but users experienced dramatic weight gain and developed a higher risk of diabetes, the new study concluded. The drug is also the most expensive.

The $44 million study, financed by the National Institute of Mental Health and to be published in Thursday's New England Journal of Medicine, indicates "substantial limitations in the effectiveness of the drugs," said Columbia University Medical School's Jeffrey Lieberman, who led the team.

But it should also help doctors choose the best therapy for the 3.2 million Americans suffering from schizophrenia, the tough-to-treat mental illness marked by delusions, hallucinations and scrambled thinking.

Because the effectiveness of a drug can vary from person to person, side effects can force patients to stop taking them or can cause doctors to switch between medicines and alter dosages to find the best, most tolerable treatment.

The new study is the "largest, longest and most comprehensive" assessment of anti-psychotic medicines ever conducted, said the institute's director, Dr. Thomas Insel.

It used the amount of time patients stayed on a drug to help gauge its effectiveness. In all, 74 percent of the 1,432 volunteers at 57 study sites stopped taking the medication they were originally assigned.

Only the schizophrenics taking Zyprexa, also known as olanzapine, stuck with it significantly longer than the other four. But still, 64 percent stopped taking it after 18 months.

The discontinuation rate was higher among the other four drugs: Seroquel (quetiapine) from AstraZeneca Plc; Risperdal (risperidone) from Johnson & Johnson; Geodon (ziprasidone) from Pfizer Inc., and perphenazine, an older generic drug.

While 15 to 20 percent of patients taking the other drugs ended up in hospital because their condition worsened, the rate was 11 percent for recipients of Zyprexa.

One surprise was that perphenazine's side effects, such as tremor, were not as common as expected. Patients tolerated it just as well as some newer drugs, and it was no less effective.

Lieberman said the fact that the older drug was at least as good as three of the newer medicines and almost as good as Zyprexa was "the biggest surprise."

And perphenazine was far cheaper.

A month's supply of perphenazine capsules costs about $50 -- compared with roughly $390 for Geodon, $425 for Risperdal, $475 for Seroquel, and $660 for Zyprexa.

Over $10 billion is spent in the United States each year on such drugs, Insel said.

Weight gain among patients on Zyprexa was significantly higher. Patients on the drug typically added two pounds (0.97 kg) a month. With two of the other drugs, patients gained up to half a pound (0.23 kg) and with the other two, they lost a small amount of weight every month.

And while all five drugs raised blood sugar levels, the gains were more than twice as high for Zyprexa.

Lilly said the weight gain and blood sugar issues were consistent with its own clinical findings but the company was delighted that the study found patients were far more likely to stay on its medication than on other drugs in the trial.

Johnson & Johnson said the effectiveness of its Risperdal in the trial was compromised by overly low doses given to patients.

Shares of Pfizer fell 1.2 percent to $25.58, while Lilly dropped 0.9 percent to $54.70, and Johnson & Johnson slipped 0.9 percent to $64.58, all on the New York Stock Exchange. AstraZeneca slipped 10 cents to $47.81, also on the NYSE, amid a moderate decline for the drug sector.

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Reference Source 89
September 20, 2005

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