Quetiapine versus other atypical antipsychotics for schizophrenia

Abstract

Background In many countries of the industrialised world second generation (’atypical’) antipsychotic drugs have become the first line drug treatment for people with schizophrenia. It is not clear how the effects of the various second generation antipsychotic drugs differ. Objectives To evaluate the effects of quetiapine compared with other second generation antipsychotic drugs for people with schizophrenia and schizophrenia-like psychosis. Search methods We searched the Cochrane Schizophrenia Group Trials Register (April 2007), inspected references of all identified studies, and contacted relevant pharmaceutical companies, drug approval agencies and authors of trials for additional information. Selection criteria We included all randomised control trials comparing oral quetiapine with oral forms of amisulpride, aripiprazole, clozapine, olanzapine, risperidone, sertindole, ziprasidone or zotepine in people with schizophrenia or schizophrenia-like psychosis. Data collection and analysis We extracted data independently. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based on a random-effects model. We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. For continuous data, we calculated weighted mean differences (WMD) again based on a random-effects model. Main results The review currently includes 21 randomised control trials (RCTs) with 4101 participants. These trials provided data on four comparisons - quetiapine versus clozapine, olanzapine, risperidone or ziprasidone. A major limitation to all findings is the high number of participants leaving studies prematurely (57.6%) and the substantial risk of biases in studies. Efficacy data favoured olanzapine and risperidone compared with quetiapine (PANSS total score versus olanzapine:10 RCTs, n=1449, WMD 3.66 CI 1.93 to 5.39; versus risperidone: 9 RCTs, n=1953, WMD 3.09 CI 1.01 to 5.16), but clinical meaning is unclear. There were no clear mental state differences when quetiapine was compared with clozapine or ziprasidone. Compared with olanzapine, quetiapine produced slightly fewer movement disorders (6 RCTs, n=1090, RR use of antiparkinson medication 0.49 CI 0.3 to 0.79, NNH 25 CI 14 to 100) and less weight gain (7 RCTs, n=1173, WMD −2.81 CI −4.38 to −1.24) and glucose elevation, but more QTc prolongation (3 RCTs, n=643, WMD 4.81 CI 0.34 to 9.28). Compared with risperidone, quetiapine induced slightly fewer movement disorders (6 RCTs, n=1715, RR use of antiparkinson medication 0.5 CI 0.3 to 0.86, NNH 20 CI 10 to 100), less prolactin increase (6 RCTs, n=1731, WMD −35.28 CI −44.36 to −26.19) and some related adverse effects, but more cholesterol increase (5 RCTs, n=1433, WMD 8.61 CI 4.66 to 12.56). Compared with ziprasidone, quetiapine induced slightly fewer extrapyramidal adverse effects (1 RCT, n=522, RR use of antiparkinson medication 0.43 CI 0.2 to 0.93, NNH not estimable) and prolactin increase. On the other hand quetiapine was more sedating and led to mor...

A Review of the Updated Pharmacophore for the Alpha 5 GABA(A) Benzodiazepine Receptor Model

“…This is an extremely important result indicating that testing a new drug for schizophrenia in humans treated for years with both typical and atypical antipsychotics may result in a false negative with regard to treatment. Studies that support this hypothesis follow here [36,38,[47][48][49][50][51][52][53][54][55][56][57][58][59][60][61].…”

A Review of the Updated Pharmacophore for the Alpha 5 GABA(A) Benzodiazepine Receptor Model

“…This is an extremely important result indicating that testing a new drug for schizophrenia in humans treated for years with both typical and atypical antipsychotics may result in a false negative with regard to treatment. Studies that support this hypothesis follow here [36,38,[47][48][49][50][51][52][53][54][55][56][57][58][59][60][61].…”

Adverse Drug Reactions Affiliated with Atypical Antipsychotics in Patients with Schizophrenia

“…Once these patients were exposed to these questionnaires for ADR' s during follow up visit the rate of spontaneous reporting increased drastically which was also similar A Cochrane database systemic review conducted in 2010 reports Quetiapine to have less side effects in terms of EPS and movement disorders compared to Olanzapine and Risperidone. 26 In the present study also, only two cases of tremors were recorded at a dose range of 100-200 mg. This antipsychotic drug is related to tricyclic compounds such as imipramine and was developed in 1960s.…”

Role of quetiapine beyond its clinical efficacy in bipolar disorder: From neuroprotection to the treatment of psychiatric disorders (Review)

“…In an RCT with a cross-over design, the acute effects of risperidone (2 mg) or quetiapine (200 mg) were assessed in patients with stable BD type I. Quetiapine was associated with more immediate adverse overall cognitive performance and sedation than risperidone ( 68 ). Conversely, Torrent et al ( 55 ) reported that, compared with olanzapine (mean dose, 7.7 mg/day) and risperidone (mean dose, 3.7 mg/day), euthymic patients with BD treated with quetiapine (mean dose, 404.1 mg/day) showed a better performance in learning, short-term memory and recognition tasks assessed with the California Verbal Learning Test, as well as in verbal fluency ( 55 ); however, this study was naturalistic, and euthymic patients with BD treated with SGAs have been shown to perform worse than stable patients treated with standard mood stabilizers ( 37 ). In summary, treatment with SGAs may be associated with adverse cognitive effects in BD, partly due to their sedative properties.…”

A Review of the Updated Pharmacophore for the Alpha 5 GABA(A) Benzodiazepine Receptor Model

“…This is an extremely important result indicating that testing a new drug for schizophrenia in humans treated for years with both typical and atypical antipsychotics may result in a false negative with regard to treatment. Studies that support this hypothesis follow here [36,38,[47][48][49][50][51][52][53][54][55][56][57][58][59][60][61].…”

Adverse Drug Reactions Affiliated with Atypical Antipsychotics in Patients with Schizophrenia

“…Once these patients were exposed to these questionnaires for ADR' s during follow up visit the rate of spontaneous reporting increased drastically which was also similar A Cochrane database systemic review conducted in 2010 reports Quetiapine to have less side effects in terms of EPS and movement disorders compared to Olanzapine and Risperidone. 26 In the present study also, only two cases of tremors were recorded at a dose range of 100-200 mg. This antipsychotic drug is related to tricyclic compounds such as imipramine and was developed in 1960s.…”

Role of quetiapine beyond its clinical efficacy in bipolar disorder: From neuroprotection to the treatment of psychiatric disorders (Review)

“…In an RCT with a cross-over design, the acute effects of risperidone (2 mg) or quetiapine (200 mg) were assessed in patients with stable BD type I. Quetiapine was associated with more immediate adverse overall cognitive performance and sedation than risperidone ( 68 ). Conversely, Torrent et al ( 55 ) reported that, compared with olanzapine (mean dose, 7.7 mg/day) and risperidone (mean dose, 3.7 mg/day), euthymic patients with BD treated with quetiapine (mean dose, 404.1 mg/day) showed a better performance in learning, short-term memory and recognition tasks assessed with the California Verbal Learning Test, as well as in verbal fluency ( 55 ); however, this study was naturalistic, and euthymic patients with BD treated with SGAs have been shown to perform worse than stable patients treated with standard mood stabilizers ( 37 ). In summary, treatment with SGAs may be associated with adverse cognitive effects in BD, partly due to their sedative properties.…”

A Review of the Updated Pharmacophore for the Alpha 5 GABA(A) Benzodiazepine Receptor Model

“…This is an extremely important result indicating that testing a new drug for schizophrenia in humans treated for years with both typical and atypical antipsychotics may result in a false negative with regard to treatment. Studies that support this hypothesis follow here [36,38,[47][48][49][50][51][52][53][54][55][56][57][58][59][60][61].…”

Adverse Drug Reactions Affiliated with Atypical Antipsychotics in Patients with Schizophrenia

“…Once these patients were exposed to these questionnaires for ADR' s during follow up visit the rate of spontaneous reporting increased drastically which was also similar A Cochrane database systemic review conducted in 2010 reports Quetiapine to have less side effects in terms of EPS and movement disorders compared to Olanzapine and Risperidone. 26 In the present study also, only two cases of tremors were recorded at a dose range of 100-200 mg. This antipsychotic drug is related to tricyclic compounds such as imipramine and was developed in 1960s.…”

Role of quetiapine beyond its clinical efficacy in bipolar disorder: From neuroprotection to the treatment of psychiatric disorders (Review)

“…In an RCT with a cross-over design, the acute effects of risperidone (2 mg) or quetiapine (200 mg) were assessed in patients with stable BD type I. Quetiapine was associated with more immediate adverse overall cognitive performance and sedation than risperidone ( 68 ). Conversely, Torrent et al ( 55 ) reported that, compared with olanzapine (mean dose, 7.7 mg/day) and risperidone (mean dose, 3.7 mg/day), euthymic patients with BD treated with quetiapine (mean dose, 404.1 mg/day) showed a better performance in learning, short-term memory and recognition tasks assessed with the California Verbal Learning Test, as well as in verbal fluency ( 55 ); however, this study was naturalistic, and euthymic patients with BD treated with SGAs have been shown to perform worse than stable patients treated with standard mood stabilizers ( 37 ). In summary, treatment with SGAs may be associated with adverse cognitive effects in BD, partly due to their sedative properties.…”