New Anti-Psychotic Drugs work better than Old

A new study has shown that people diagnosed with their first episode of schizophrenia fare much better when treated with newer anti-psychotic drugs than with traditional medications. The double bind study was conducted in China by American and Chinese scientists. It is the first study to directly compare treatment with clozapine (Clozaril), an 'atypical' anti-psychotic medication, with chlorpromazine (Thorazine) in people who had an episode of schizophrenia for the first time.

200 patients diagnosed with first-episode schizophrenia were randomized to receive one drug or the other. Neither they nor the scientists knew who received which drug until all the data had been collected. The findings strongly suggest that clozapine works better than chlorpromazine in early schizophrenia.

The findings of this study were presented December 11, 2000 to the 39th Annual Meeting of the American College of Neuropsychopharmacology. Jeffrey A. Lieberman, M.D. of the University of North Carolina summarized the study this way: "We found that clozapine acts faster and produced fewer patients who drop out or stop treatment because of side effects. This is the first time a study's ever been done comparing the prototype of this new class of drugs with the old group in a large sample of patients."

Clozapine is the second most widely used medication for schizophrenia in China, but its use is restricted in the United States. The FDA approved clozapine as a 2nd- or 3rd-line of treatment for people who were unresponsive to other medications because early studies showed it suppressed the immune system's white cells in one percent of people who took it for more than six weeks . The authors conducted the study in China where these restrictions do not exist.

Based on the study's results Lieberman sees a wider role for the newer medications. "We think using these new drugs as first-line medications increases the likelihood of recovering from the illness and reduces the likelihood of a second episode when they remain in treatment. Patients who are at the beginning of their illness are extremely sensitive to treatment. That sensitivity makes them very responsive to the therapeutic effects of anti-psychotic drugs. They respond to all treatment including the newer and better treatments. However, they're also more sensitive to side effects and this can become a real problem in terms of their willingness to continue their medication and the likelihood of them stopping."

In a footnote, the study also found that patients in the study whose blood tests showed signs of exposure to the parasite toxoplasmosis had a poor response to treatment. Toxoplasmosis is a parasite borne by cats and some other domestic animals. Lieberman speculated on this result: "There's a theory that an infectious agent, a parasite or some other microorganism, can cause schizophrenia - and toxoplasmosis has an affinity for the nervous system, where it can lie dormant for a long time in its migration to the brain." Lieberman suggested that schizophrenic patients in a population with a high risk for toxoplasmosis should be given standard anti-psychotic medication along with one of the drugs typically used against the parasite.

Clozapine was the very first of the new 'atypical antipsychotic' medications. Other medications in this class seem to have some of the benefits without the infrequent dangerous side-effect. This study suggests that physicians should at least consider a medication in this class for patients newly diagnosed with schizophrenia. Is there still a role for older anti-psychotics? Maybe - but their role continues to shrink.