Olanzapine compared to quetiapine in adolescents with a first psychotic episode

Abstract

Objective: To compare the efficacy, safety, and tolerability of olanzapine and quetiapine in adolescents with first episode psychosis. Method: Fifty adolescents (age 16 ± 1.25) with a first episode of psychosis were randomized to quetiapine or olanzapine in a 6-month open label study. Efficacy and side effect scales, as well as vital signs and laboratory data were recorded at baseline, 7, 15, 30, 90, and 180 days (end of study). Results: Out of the total sample included in the study, 32 patients completed the trial (quetiapine n = 16, olanzapine n = 16). Patients in both treatment groups had a significant reduction in all clinical scales with the exception of the negative scale of the Positive and Negative Symptom Scale (PANSS) for olanzapine and the general psychopathology scale of the PANSS for quetiapine. The only difference between treatment arms on the clinical scales was observed on the patients' strength and difficulties questionnaire (SDQ) scale, with greater improvement for olanzapine. Patients on olanzapine gained 15.5 kg and patients on quetiapine gained 5.5 kg. Conclusion: Olanzapine and quetiapine reduced psychotic symptoms in this adolescent sample. Patients on olanzapine gained significantly more weight. Side effects with both drugs seemed to be more prevalent than those reported in adult studies

Olanzapine Use for the Adjunctive Treatment of Adolescents with Anorexia Nervosa

“…Although the body of evidence investigating the potential role for adjunctive olanzapine therapy in severely ill individuals with AN is growing, data regarding tolerability are sparse. Studies completed in non-ED adolescent populations have demonstrated substantial concerns with excessive weight gain, dyslipidemia, and metabolic disturbances in populations treated with atypical antipsychotics, especially olanzapine (Arango et al 2009;Kryzhanovskaya et al 2009;Swadi et al 2010). Our study suggests a high-observed rate of side effects attributable to olanzapine, with the most commonly cited side effect being sedation.…”

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

“…Moreover, the generalizability of the efficacy observed in selected samples consenting to participate in RCTs to populations treated in general practice settings is less clear. Furthermore, because more chronically ill patients are overrepresented in RCTs, very little is known about outcomes in youth with short illness duration or even naïve to antipsychotic treatment (Sikich et al 2008;Arango et al 2009). …”

Management of Adverse Effects of Second-generation Antipsychotics in Youth

“…All 10 studies assessing risperidone reported weight gain in the exposed group (n=358). When comparing different SGAs, weight gain was significantly higher for olanzapine compared to risperidone, clozapine, or quetiapine [14,21,22]. One study on quetiapine (n=10) reported no significant weight gain or increase in BMI after 64 weeks of treatment [24], while another study reported only moderate weight gain (n=24, duration 25 weeks) [14].…”

“…First, we will discuss the major AEs found in both short-and long-term studies on the use of SGAs in youth. This is based on an in-depth literature review of a Bayesian meta-analysis based on short-term studies [12•]; a review of long-term studies in SGAs [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]; and our own clinical experience in managing such treatment in youth. Second, we will present the major AEs by compound.…”