A Comparison of Ziprasidone and Risperidone in the Long-Term Treatment of Schizophrenia: A 44-Week, Double-Blind, Continuation Study

Abstract

W La Revue canadienne de psychiatrie, vol 54, no 1, janvier 2009 46Objective: This randomized, double-blind, multicentre extension study compared the efficacy, tolerability, and safety of ziprasidone and risperidone for schizophrenia or schizoaffective disorder. Methods:Patients who had responded to treatment for an acute exacerbation of illness in an 8-week study received ziprasidone, 80 to 160 mg/day (n = 62), or risperidone, 6 to 10 mg/day (n = 77), for up to 44 additional weeks. Primary efficacy variables included changes in Positive and Negative Syndrome Scale (PANSS) total score and Clinical Global Impression Severity (CGI-S) score. Tolerability and safety assessments included movement disorders, adverse events, study discontinuation rates, and weight and metabolic parameters.Results: Both the ziprasidone and risperidone groups showed statistical improvement from baseline in PANSS and CGI-S scores at study end point with no significant differences between treatment groups. More risperidone-treated patients completed the study (41.6%) than ziprasidone-treated patients (33.9%), but the difference was not statistically significant. Ziprasidone-treated patients who completed the study showed greater improvement in depressive symptoms assessed by Montgomery and Asberg Depression Rating Scale than risperidone-treated patients (P < 0.05). Ziprasidone was associated with a more favourable effect on extrapyramidal symptom (EPS) measures and prolactin as well as less weight gain than risperidone. Median dosages were ziprasidone 120 mg/day and risperidone 8 mg/day. Conclusions:Ziprasidone and risperidone demonstrated similar efficacy during long-term treatment of patients with schizophrenia or schizoaffective disorder. While more subjects on risperidone completed the extension study, ziprasidone was associated with fewer adverse effects on weight, EPS measures, and prolactin than risperidone.Can J Psychiatry. 2009;54(1):46-54. Clinical Implications· Both ziprasidone and risperidone were effective as continuation and maintenance treatment in patients recovering from acute exacerbations of schizophrenia or schizoaffective disorder. · Risperidone had greater adverse effects on weight gain, EPS measures, and prolactin than ziprasidone. · Ziprasidone may be associated with beneficial effects on depressive symptoms associated with schizophrenia in patients undergoing long-term treatment, based on a post hoc analysis. Limitations· Study dosages diverged somewhat from current clinical practice. The mean ziprasidone dosage was lower than that generally associated with maximum efficacy; risperidone dosage was higher than currently thought optimal in the treatment of schizophrenia. · The patient sample involved people who had responded to treatment (based on investigator judgment) for an acute exacerbation of illness. It is not known whether these results can be fully generalized to unselected patients with schizophrenia. · The number of subjects in the study may not have been large enough to document statistically significant ...

Long-Term Efficacy and Tolerability of Clozapine Combined with Ziprasidone or Risperidone

“…The results of both the acute and long-term treatment documented similar effi cacy and a diff erential pattern of side eff ects in both treatment arms. This is widely in concert with previous comparisons of ziprasidone and risperidone in monotherapy [2,16] , switch studies between the two antipsychotics [18,36,37] as well as one recent long-term comparison over a period of 44 weeks [1] . As for the mode of action on psychotic symptoms and mood, we assume pharmacodynamic eff ects via receptors of several neurotransmitter systems.…”

The Effects of Novel and Newly Approved Antipsychotics on Serum Prolactin Levels: A Comprehensive Review

“…Most reports indicate a low incidence of PRL elevation and low to moderate levels of HPRL with ziprasidone use [11, 15, 103, 234, 240, 245, 297, 324–326]. Several studies found decreased PRL levels after, respectively, 6 weeks [301], 4–8 weeks [90], 18 weeks [327], 44 weeks [328] and 1 year [329] of treatment with ziprasidone. However, ziprasidone can also be associated with HPRL.…”

Tratamiento con antipsicóticos de mantenimiento del paciente adulto con diagnóstico de esquizofrenia

“…Los efectos de diferentes AP de segunda generación fueron comparados entre ellos en 5 meta análisis 20-24 y 1 experimento clínico 25 . En la tabla 5 se presenta el resumen de la Tabla 3 -Resumen de la evidencia de riesgo de hospitalización en las comparaciones entre AP de primera generación con los de segunda generación para el tratamiento de mantenimiento de la esquizofrenia Tabla 4 -Resumen de la evidencia de falla en el tratamiento en las comparaciones entre AP de primera generación con los de segunda generación para el tratamiento de mantenimiento de la esquizofrenia evidencia y la calidadde los desenlaces con información para estas comparaciones.…”

“…El único de los estudios incluidos que evaluó la evolución de los síntomas negativos durante el manejo en fase de mantenimiento fue el experimento conducido por Addington y colaboradores 25 . Se observa una diferencia estadísticamente significativa en la disminución de los síntomas con el uso de ziprasidona comparada con risperidona utilizando la subescala de síntomas negativos de la escala PANSS, pero con limitada importancia clínica (DM: −2.2 (IC 95% −1,67; −2,72)).…”