Efficacy of olanzapine in comparison with clozapine for treatment-resistant schizophrenia: evidence from a systematic review and meta-analyses

Souza, Juliano Santos; Kayo, Monica; Tassell, Ivson; Martins, Camila Bertini; Elkis, Hélio

doi:10.1017/s1092852912000806

Cited by 52 publications

(27 citation statements)

References 54 publications

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“…The rates of clozapine prescription for TRS patients found in Brazilian community centers were similar to rates found in studies carried out in the United States 28,29 , an especially low proportion when compared to other countries 26,27,30 . Clozapine was only prescribed for 22 individuals, which represents 21.4% of the TRS patients, or 5% of the total number of schizophrenia patients, despite the abundant evidence of clozapine's superior efficacy and effectiveness compared with other antipsychotic drugs in the treatment of TRS patients 6,7,8,13,31,32 . Current clinical practice guidelines for the treatment of schizophrenia recommend that a trial of clozapine should be offered after the identification of resistance to antipsychotic treatment 1,15,33,34 , which suggests that the major part of the psychiatrists participating in our study do not follow strictly to guideline recommendations, a feature also observed in other parts of the world 22,35 .…”

Section: Discussionmentioning

confidence: 99%

Patterns of clozapine and other antipsychotics prescriptions in patients with treatment-resistant schizophrenia in community mental health centers in São Paulo, Brazil

Silveira¹,

Rocha²,

Àttux³

et al. 2015

Arch. Clin. Psychiatry (São Paulo)

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Background: Despite of its global underuse, clozapine is still the golden standard antipsychotic for patients with treatment-resistant schizophrenia (TRS). Objective: To evaluate the patterns of clozapine and other antipsychotic drugs prescription in TRS in community mental health centers in São Paulo, Brazil. Methods: A multiple-choice questionnaire was applied to fifteen psychiatrists at five centers inquiring about patients' clinical condition, adherence to oral treatment and current antipsychotic treatment. History of previous and current antipsychotic treatment was collected through medical chart review. Results: Out of 442 schizophrenia patients, 103 (23.3%) fulfilled the criteria for TRS. Fifty-eight patients (56.3%) were receiving polypharmacy; 30 (29.1%) were on atypical antipsychotic monotherapy, 14 (13.6%) were on typical antipsychotic monotherapy, 25 (24.3%) were taking depot antipsychotic medication and only 22 (21.4%) were receiving clozapine. Discussion: As well as in other parts of the world, many TRS patients (78.6%) receive other drugs instead of clozapine in São Paulo, the best evidence-based medication for patients with TRS. The government should make every effort to provide medical training and the equipment and logistic support to adequately serve those who could benefit from clozapine treatment at the community health centers.

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Section: Discussionmentioning

confidence: 99%

Patterns of clozapine and other antipsychotics prescriptions in patients with treatment-resistant schizophrenia in community mental health centers in São Paulo, Brazil

Silveira¹,

Rocha²,

Àttux³

et al. 2015

Arch. Clin. Psychiatry (São Paulo)

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“…Several RCTs in people with schizophrenia have assessed the cognitive effect of agents that modulate neurotransmission at the NMDA receptor glycine binding site including the intrinsic coagonists glycine and D-serine and the partial agonist D-cycloserine. Adjunctive administration of glycine (Buchanan et al, 2007), D-serine (Kantrowitz et al, 2015;Weiser et al, 2012) and D-cycloserine (Buchanan et al, 2007;Goff et al, 2008;Takiguchi et al, 2017) did not improve cognitive function, nor did D-serine when given in an attempt to boost cognitive remediation training (D' Souza et al, 2013). In a novel paradigm, Cain et al (2014) examined the effect of intermittent weekly administration of D-cycloserine while patients took part in a 'Brain Fitness' programme in which an auditory discrimination task was practised 3-5 times a week.…”

Section: Nmda Receptor Agonists and Modulatorsmentioning

confidence: 99%

“…A systematic review and meta-analyses by Souza et al (2013) included seven RCTs that had compared olanzapine with clozapine in patients with TRS. Clozapine was found to be superior to olanzapine for the treatment of positive and negative symptoms.…”

Section: Recommendations Regarding Clozapine Treatment For Treatment-mentioning

confidence: 99%

Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology

2019

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These updated guidelines from the British Association for Psychopharmacology replace the original version published in 2011. They address the scope and targets of pharmacological treatment for schizophrenia. A consensus meeting was held in 2017, involving experts in schizophrenia and its treatment.They were asked to review key areas and consider the strength of the evidence on the risk-benefit balance of pharmacological interventions and the clinical implications, with an emphasis on meta-analyses, systematic reviews and randomised controlled trials where available, plus updates on current clinical practice. The guidelines cover the pharmacological management and treatment of schizophrenia across the various stages of the illness, including first-episode, relapse prevention, and illness that has proved refractory to standard treatment. It is hoped that the practice recommendations presented will support clinical decision making for practitioners, serve as a source of information for patients and carers, and inform quality improvement.

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“…In terms of relapse prevention, SGAs have a modest benefit compared with FGAs [73]. Newer antipsychotics such as asenapine, iloperidone, lurasidone, and paliperidone do not seem to be significantly better than haloperidol [61], and for the treatment of refractory schizophrenia, clozapine has been shown to be significantly more efficacious than other agents [74-78]. However, several studies suggest that olanzapine and risperidone have greater efficacy over other antipsychotics, but this remains controversial and more research is necessary in this area.…”

Section: Pharmacological Treatments In Schizophreniamentioning

confidence: 99%

Recent advances in understanding schizophrenia

Haller¹,

Padmanabhan²,

Lizano³

et al. 2014

F1000Prime Rep

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Schizophrenia is a highly disabling disorder whose causes remain to be better understood, and treatments have to be improved. However, several recent advances have been made in diagnosis, etiopathology, and treatment. Whereas reliability of diagnosis has improved with operational criteria, including Diagnostic and Statistical Manual of Mental Disorders, (DSM) Fifth Edition, validity of the disease boundaries remains unclear because of substantive overlaps with other psychotic disorders. Recent emphasis on dimensional approaches and translational bio-behavioral research domain criteria may eventually help move toward a neuroscience-based definition of schizophrenia. The etiology of schizophrenia is now thought to be multifactorial, with multiple small-effect and fewer large-effect susceptibility genes interacting with several environmental factors. These factors may lead to developmentally mediated alterations in neuroplasticity, manifesting in a cascade of neurotransmitter and circuit dysfunctions and impaired connectivity with an onset around early adolescence. Such etiopathological understanding has motivated a renewed search for novel pharmacological as well as psychotherapeutic targets. Addressing the core features of the illness, such as cognitive deficits and negative symptoms, and developing hypothesis-driven early interventions and preventive strategies are high-priority goals for the field. Schizophrenia is a severe, chronic mental disorder and is among the most disabling disorders in all of medicine. It is estimated by the National Institute of Mental Health (NIMH) that 2.4 million people over the age of 18 in the US suffer from schizophrenia. This illness typically begins in adolescence and derails the formative goals of school, family, and work, leading to considerable suffering and disability and reduced life expectancy by about 20 years. Treatment outcomes are variable, and some people are successfully treated and reintegrated (i.e. go back to work). Despite the effort of many experts in the field, however, schizophrenia remains a chronic relapsing and remitting disorder associated with significant impairments in social and vocational functioning and a shortened lifespan. Comprehensive treatment entails a multi-modal approach, including psychopharmacology, psychosocial interventions, and assistance with housing and financial sustenance. Research to date suggests a network of genetic, neural, behavioral, and environmental factors to be responsible for its development and course. This article aims to summarize and explain recent advancements in research on schizophrenia, to suggest how these recent discoveries may lead to a better understanding and possible further development of effective therapies, and to highlight the paradigm shifts that have taken place in our understanding of the diagnosis, etiopathology, and treatment.

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Efficacy of olanzapine in comparison with clozapine for treatment-resistant schizophrenia: evidence from a systematic review and meta-analyses

Abstract: The results of this study suggest that clozapine is significantly more efficacious than olanzapine in improving positive and negative symptoms in TRS patients.

Cited by 52 publications

References 54 publications

Patterns of clozapine and other antipsychotics prescriptions in patients with treatment-resistant schizophrenia in community mental health centers in São Paulo, Brazil

Patterns of clozapine and other antipsychotics prescriptions in patients with treatment-resistant schizophrenia in community mental health centers in São Paulo, Brazil

Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology

Recent advances in understanding schizophrenia

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