Comments on: New Antipsychotics No Better For First Episodes http://www.pharmalot.com/2008/03/new-antipsychotics-no-better-for-first-episodes/ News, Comment and Conversation Fri, 10 Feb 2012 20:56:12 +0000 http://wordpress.org/?v=2.6.2 By: Jack2 http://www.pharmalot.com/2008/03/new-antipsychotics-no-better-for-first-episodes/#comment-232283 Jack2 Fri, 28 Mar 2008 19:55:49 +0000 http://www.pharmalot.com/2008/03/new-antipsychotics-no-better-for-first-episodes/#comment-232283 Exactly Atlex. Horus, With the patent life running down on those atypicals (except maybe ziprasidone - I don't really now), I don't think you'll see much more industry funded research on those drugs no matter how tantalizing. As a serotonin and dopamine antagonist I'd call Risperdal an atypical. Exactly Atlex.

Horus,
With the patent life running down on those atypicals (except maybe ziprasidone - I don’t really now), I don’t think you’ll see much more industry funded research on those drugs no matter how tantalizing. As a serotonin and dopamine antagonist I’d call Risperdal an atypical.

]]> By: Atlex http://www.pharmalot.com/2008/03/new-antipsychotics-no-better-for-first-episodes/#comment-232250 Atlex Fri, 28 Mar 2008 19:37:29 +0000 http://www.pharmalot.com/2008/03/new-antipsychotics-no-better-for-first-episodes/#comment-232250 Despite what the authors state, they essentially conclude that atypicals do work better than older antipsychotics. Assuming atypicals and older antipsychotics work 50% (this number may or may not be accurate) of the time, out 100 patients taking an atypical, roughly 35 benefit (1/2 of the 70% that are adherent). For older antipsychotics, the number would be 19 to 25 (1/2 of the 37% to 50% who are adherent). Despite what the authors state, they essentially conclude that atypicals do work better than older antipsychotics. Assuming atypicals and older antipsychotics work 50% (this number may or may not be accurate) of the time, out 100 patients taking an atypical, roughly 35 benefit (1/2 of the 70% that are adherent). For older antipsychotics, the number would be 19 to 25 (1/2 of the 37% to 50% who are adherent).

]]> By: HorusCat http://www.pharmalot.com/2008/03/new-antipsychotics-no-better-for-first-episodes/#comment-232249 HorusCat Fri, 28 Mar 2008 19:35:11 +0000 http://www.pharmalot.com/2008/03/new-antipsychotics-no-better-for-first-episodes/#comment-232249 Jack2, You know, if Zyprexa didn't cause weight gain and possibly diabetes, it would take over the world. I hate to admit it, but it is a great drug. I don't know where Risperdal is...but you know, it's kind of in-between the typicals and the atypicals... If you read my first post about atypicals perhaps offering more in the way of "neuro-protection," then you might agree that it is worth investigating them further for more than just positive and negative symptom control. Jack2,

You know, if Zyprexa didn’t cause weight gain and possibly diabetes, it would take over the world. I hate to admit it, but it is a great drug. I don’t know where Risperdal is…but you know, it’s kind of in-between the typicals and the atypicals…

If you read my first post about atypicals perhaps offering more in the way of “neuro-protection,” then you might agree that it is worth investigating them further for more than just positive and negative symptom control.

]]> By: Jack2 http://www.pharmalot.com/2008/03/new-antipsychotics-no-better-for-first-episodes/#comment-232241 Jack2 Fri, 28 Mar 2008 19:28:10 +0000 http://www.pharmalot.com/2008/03/new-antipsychotics-no-better-for-first-episodes/#comment-232241 I just look at the data and think the FACTS in this study read like an advertisement for Zyprexa. Yet the editorial just jumps on the bandwagon that we need to rethink atypicals. Was there ever a concensus that atypicals worked better than typicals? Not to my knowledge. I think the concensus came down to better tolerability (less EPS), and maybe a stronger effect on negative symptoms (or less of a drug induced decline in negative symptoms). I think this study actually SUPPORTS the notion of better tolerability. I didn't read the whole study. Why no Risperdal? It's practically the benchmark. I just look at the data and think the FACTS in this study read like an advertisement for Zyprexa. Yet the editorial just jumps on the bandwagon that we need to rethink atypicals. Was there ever a concensus that atypicals worked better than typicals? Not to my knowledge. I think the concensus came down to better tolerability (less EPS), and maybe a stronger effect on negative symptoms (or less of a drug induced decline in negative symptoms). I think this study actually SUPPORTS the notion of better tolerability.

I didn’t read the whole study. Why no Risperdal? It’s practically the benchmark.

]]> By: HorusCat http://www.pharmalot.com/2008/03/new-antipsychotics-no-better-for-first-episodes/#comment-232229 HorusCat Fri, 28 Mar 2008 19:20:42 +0000 http://www.pharmalot.com/2008/03/new-antipsychotics-no-better-for-first-episodes/#comment-232229 Jack2, Thanks for chiming in. From what I can tell from conversations with doctors and patients, the atypicals are better-tolerated. Compliance is a huge issue with antipsychotics, as you probably know. (Compliance is a problem with all Americans, but it becomes really obviously a problem when the non-compliant person becomes delusional and paranoid in public!) The atypicals are better, but still... When Janssen came out with Consta, it was a big step forward for the long-acting injectibles, because it is much better tolerated than Haldol dec. From what I hear, the Lilly long-acting Zyprexa worked phenomenally well, but the side effects scared off the FDA. It is notoriously hard to formulate a long-acting antipsychotic. Pfizer tried with Geodon, but finally gave up. I think our medications for schizophrenia are going to get better and better. For a relatively small portion of the population (1%), they chew up a lot of medical resources. Not only because antipsychotics are expensive, but because providing the ancillary support services that keep patients out of the hospital is expensive; and hospital stays really eat up the money. Jack2,
Thanks for chiming in. From what I can tell from conversations with doctors and patients, the atypicals are better-tolerated. Compliance is a huge issue with antipsychotics, as you probably know. (Compliance is a problem with all Americans, but it becomes really obviously a problem when the non-compliant person becomes delusional and paranoid in public!) The atypicals are better, but still… When Janssen came out with Consta, it was a big step forward for the long-acting injectibles, because it is much better tolerated than Haldol dec. From what I hear, the Lilly long-acting Zyprexa worked phenomenally well, but the side effects scared off the FDA. It is notoriously hard to formulate a long-acting antipsychotic. Pfizer tried with Geodon, but finally gave up.

I think our medications for schizophrenia are going to get better and better. For a relatively small portion of the population (1%), they chew up a lot of medical resources. Not only because antipsychotics are expensive, but because providing the ancillary support services that keep patients out of the hospital is expensive; and hospital stays really eat up the money.

]]> By: Jack2 http://www.pharmalot.com/2008/03/new-antipsychotics-no-better-for-first-episodes/#comment-232218 Jack2 Fri, 28 Mar 2008 19:14:46 +0000 http://www.pharmalot.com/2008/03/new-antipsychotics-no-better-for-first-episodes/#comment-232218 Discontinuation Rate over 12 months: Haloperidol: 63% Quetiapine: 51% Amisulpride: 32% Ziprasidone: 31% Olanzapine: 30% ....and that's not positive data for the atypicals?!? Discontinuation Rate over 12 months:
Haloperidol: 63%
Quetiapine: 51%
Amisulpride: 32%
Ziprasidone: 31%
Olanzapine: 30%

….and that’s not positive data for the atypicals?!?

]]> By: HorusCat http://www.pharmalot.com/2008/03/new-antipsychotics-no-better-for-first-episodes/#comment-232174 HorusCat Fri, 28 Mar 2008 18:46:03 +0000 http://www.pharmalot.com/2008/03/new-antipsychotics-no-better-for-first-episodes/#comment-232174 Laurie, Of course there are a lot of "coulds, mays and mights" right now. Researchers are learning exponentially more about schizophrenia and brain function. Multiple genes and multiple neurotransmitters are involved; there may be different subsets of people who have different deficits. This is another area where pharmacogenomics may eventually be helpful. And it's not a matter of increased brain mass, it's a matter of decreasing atrophy. We know that the brain of a person with a 40 year history of schizophrenia looks far different than that of a person with no such history. I think it's a really exciting time for researchers, and they are hoping for real breakthroughs. Not all the atypicals have equal metabolic risks. And even those that do have usefulness. Someone with schizophrenia who is able to really function while taking Zyprexa may be willing to take the metabolic risk because he is so appreciative of the way he feels while taking the drug. The typicals carry risks, too. Tardive dyskinesia is a horrible thing to live with. The atypicals are not perfect medicines. Researchers and doctors alike are frustrated with the limitations of the medications currently available. I think the common goal is to find a way for a person suffering from schizophrenia to live as fully and completely as possible--and to make that "as possible" as big as we can. Laurie,
Of course there are a lot of “coulds, mays and mights” right now. Researchers are learning exponentially more about schizophrenia and brain function. Multiple genes and multiple neurotransmitters are involved; there may be different subsets of people who have different deficits. This is another area where pharmacogenomics may eventually be helpful. And it’s not a matter of increased brain mass, it’s a matter of decreasing atrophy. We know that the brain of a person with a 40 year history of schizophrenia looks far different than that of a person with no such history. I think it’s a really exciting time for researchers, and they are hoping for real breakthroughs.

Not all the atypicals have equal metabolic risks. And even those that do have usefulness. Someone with schizophrenia who is able to really function while taking Zyprexa may be willing to take the metabolic risk because he is so appreciative of the way he feels while taking the drug. The typicals carry risks, too. Tardive dyskinesia is a horrible thing to live with.

The atypicals are not perfect medicines. Researchers and doctors alike are frustrated with the limitations of the medications currently available. I think the common goal is to find a way for a person suffering from schizophrenia to live as fully and completely as possible–and to make that “as possible” as big as we can.

]]> By: Laurie http://www.pharmalot.com/2008/03/new-antipsychotics-no-better-for-first-episodes/#comment-232117 Laurie Fri, 28 Mar 2008 18:02:19 +0000 http://www.pharmalot.com/2008/03/new-antipsychotics-no-better-for-first-episodes/#comment-232117 "Tantalizing preliminary research suggests that the first-break schizophrenic may have more to gain from using the atypicals than the chronic schizophrenic with many years of disease behind him." The preliminary has a lot of "could, may, and might" in those studies. And then one has to weigh the risk of diabetes vs a "possible" positive effect on brain mass. Then the definitive question of what does increase brain mass mean to function.... “Tantalizing preliminary research suggests that the first-break schizophrenic may have more to gain from using the atypicals than the chronic schizophrenic with many years of disease behind him.”

The preliminary has a lot of “could, may, and might” in those studies. And then one has to weigh the risk of diabetes vs a “possible” positive effect on brain mass. Then the definitive question of what does increase brain mass mean to function….

]]> By: HorusCat http://www.pharmalot.com/2008/03/new-antipsychotics-no-better-for-first-episodes/#comment-231592 HorusCat Fri, 28 Mar 2008 12:22:36 +0000 http://www.pharmalot.com/2008/03/new-antipsychotics-no-better-for-first-episodes/#comment-231592 This is an interesting spin on what we already know: there is no difference in efficacy between the older antipsychotics and the newer ones. There may be a difference in "negative" symptoms--this is a hard parameter to measure. What we do know is there is a difference in side effects between older and newer antipsychotics. Surely, a patient's quality of life should enter into the equation when choosing a medication. Unfortunately, those suffering from schizophrenia don't have many willing to speak up for them. An interesting aspect of research occurring right now is whether or not the newer antipsychotics preserve function and prevent atrophy in the schizophrenic brain. Tantalizing preliminary research suggests that the first-break schizophrenic may have more to gain from using the atypicals than the chronic schizophrenic with many years of disease behind him. This is an interesting spin on what we already know: there is no difference in efficacy between the older antipsychotics and the newer ones. There may be a difference in “negative” symptoms–this is a hard parameter to measure.

What we do know is there is a difference in side effects between older and newer antipsychotics. Surely, a patient’s quality of life should enter into the equation when choosing a medication. Unfortunately, those suffering from schizophrenia don’t have many willing to speak up for them.

An interesting aspect of research occurring right now is whether or not the newer antipsychotics preserve function and prevent atrophy in the schizophrenic brain. Tantalizing preliminary research suggests that the first-break schizophrenic may have more to gain from using the atypicals than the chronic schizophrenic with many years of disease behind him.

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