A trial of quetiapine compared with risperidone in the treatment of first onset psychosis among 15- to 18-year-old adolescents

Abstract

The objective of this study was to evaluate the efficacy and tolerability of quetiapine in the treatment of first onset psychosis in older adolescents using risperidone as a comparator. Twenty-two patients with first onset psychosis were randomized to receive quetiapine (up to 800 mg/day) or risperidone (up to 6 mg/day) for 6 weeks. Raters blind to treatment assignment performed outcome symptom ratings. No statistical differences emerged in terms of efficacy or tolerability between the two drugs. However, there were some clinically notable differences that seem to favour the efficacy of risperidone over quetiapine. Patients taking quetiapine, although improved, showed less clinical improvement on scores for total positive and negative symptoms, clinical global severity and depression at 6 weeks than patients taking risperidone. Although both treatments were associated with weight gain and sedation, more patients on quetiapine experienced over 10% weight gain. However, fewer patients who were taking quetiapine required anticholinergic medication or experienced extrapyramidal side effects than patients taking risperidone. Risperidone was significantly more likely to be associated with elevation in serum prolactin levels in this population. In conclusion, the results in this small trial show that adolescent patients may benefit more from treatment with risperidone than quetiapine. However, those susceptible to side effects, particularly hyperprolactinaemia, may be more suitable for treatment with quetiapine.

Outcome of Youth with Early-Phase Schizophrenia-Spectrum Disorders and Psychosis Not Otherwise Specified Treated with Second-Generation Antipsychotics: 12 Week Results from a Prospective, Naturalistic Cohort Study

“…Relatively limited research is available on the epidemiology, clinical characteristics, and outcome of PsyNOS. Although many clinical studies include patients with PsyNOS (Wozniak et al 2008;Rapado-Castro et al 2010;Swadi et al 2010;Hassan and Taha 2011), studies rarely specify the outcome for different types of psychotic disorders, but either focus solely on schizophrenia or treat all psychotic disorders as one group. Moreover, trials just focusing on patients with Psy-NOS are lacking.…”

Efectos adversos metabólicos y endocrinos de los antipsicóticos de segunda generación en niños y adolescentes: una revisión sistemática de ensayos aleatorizados, controlados con placebo y guías de práctica clínica

“…La hiperprolactinemia inducida por antipsicóticos en los niños puede normalizarse con el paso del tiempo, pero la posibilidad de un retraso del desarrollo puberal es motivo de preocupación. Según indican los datos existentes, que son limitados y corresponden solamente a resultados a medio plazo, la mayoría de los niños y adolescentes tratados con risperidona, que es el fármaco con mayor tendencia a elevar la prolactina, parecen tener una evolución normal durante la pubertad 20,121 . En un estudio, el 28% de los niños presentaron niveles de prolactina de más del doble del límite superior de la normalidad, pero ninguno de ellos mostró signos clínicos de hiperprolactinemia a las 10 semanas 41 .…”

“…Dicho efecto puede ser más pronunciado en los niños y adolescentes tras la pubertad, en comparación con los adultos. Esto puede ser consecuencia de una disminución de los receptores de dopamina en relación con la edad 20,121 . Los síntomas clínicos de la hiperprolactinemia se indican en la tabla 6.…”

Quetiapine versus aripiprazole in children and adolescents with psychosis - protocol for the randomised, blinded clinical Tolerability and Efficacy of Antipsychotics (TEA) trial

“…Consequently, we used a conservative estimate of the (at that time) highest reported SD of 7.4 in the original sample size estimation. Since then, however, more studies on aripiprazole and quetiapine in early onset psychosis point toward lower SDs on the PANSS-P ranging from 4.3 to 6.3 [15,21,28] (see all relevant studies in Table 3). A weighted mean SD of PANSS-P based on data from all 6 studies in Table 3 equals 5.48 for all SDs, and 5.68 for SDs of change scores.…”

“…Only 12 randomised clinical trials (RCTs) compared different antipsychotics in the treatment of EOP. Five RCTs were open-label head-to-head studies investigating olanzapine versus (vs) risperidone (n = 44, including adolescents and young adults aged 16-28 years) [18]; risperidone vs olanzapine vs quetiapine (n = 30) [19]; olanzapine vs quetiapine (n = 50) [20]; quetiapine vs risperidone (n = 22) [21]; and olanzapine vs risperidone (n = 25) [22]. Six RCTs were double-blind, head-to-head trials investigating clozapine vs haloperidol (n = 21) [23]; clozapine vs olanzapine (n = 39) [24]; clozapine vs olanzapine (n = 25) [25]; risperidone vs olanzapine vs haloperidol (n = 50, including both non-affective and affective psychotic disorders) [26]; olanzapine vs risperidone vs molindone (n = 119) [27]; and a double-blind RCT (n = 126) comparing paliperidone vs aripiprazole [28].…”