Randomized trial of clozapine vs. risperidone in treatment-naïve first-episode schizophrenia: Results after one year

Sanz-Fuentenebro, Javier; Taboada, Diana; Palomo, Tomás; Aragüés, Marı́a; Ovejero, Santiago; Alamo, C.; Molina, Vicente

doi:10.1016/j.schres.2013.07.003

Cited by 32 publications

(31 citation statements)

References 30 publications

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“…Five studies were double blinded, [32][33][34][35][36] one was single blinded, 37 and 22 were open label. 20,24,31,[38][39][40][41][42][43][44][45][46][47][48][49][50][51][52] Of these 28 studies, 12 (42.8%) were funded by pharmaceutical companies, 6 (21.4%) were funded by institutional or government agencies, and 3 (10.7%) were funded by pharmaceutical companies and institutional agencies. Six studies were carried out independently.…”

Section: Resultsmentioning

confidence: 99%

Antipsychotic-Induced Weight Gain in First-Episode Psychosis Patients: A Meta-Analysis of Differential Effects of Antipsychotic Medications

Tek

Küçükgöncü

Gülöksüz

et al. 2016

FOC

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Aim-The first-episode psychosis (FEP) represents a critical period to prevent cardiovascular and metabolic morbidity decades later. Antipsychotic (AP)-induced weight gain is one modifiable factor in this period. The purpose of this study is to conduct a meta-analysis of AP-induced weight and body mass index (BMI) change in FEP.Methods-A comprehensive literature search identified 28 articles that reported data on APspecific weight or BMI change in FEP. We conducted a meta-analysis of short-and long-term mean weight and BMI differences between placebo and AP medications. We also performed subgroup and meta-regression analysis to examine weight, BMI outcomes and their relationship with location (Asian vs. Western), sponsorship and baseline weight and BMIs.Results-Compared to placebo, AP-caused mean weight gain was 3.22 kg and 1.4 points BMI in the short-term, and 5.30 kg and 1.86 points BMI in the long term. Clinically significant weight gain risk increased about twofold with AP use. Weight gain was associated with duration of AP use. AP medications were associated with more weight gain in Western samples as opposed to Asian samples. Most AP medications were associated with significant body weight gain and BMI increase in FEP patients, except for ziprasidone. Olanzapine and clozapine caused the highest weight gain compared to placebo.Conclusion-Except for ziprasidone, most AP medications were associated with body weight gain and BMI increase in FEP patients. Early and continuing effects of various AP medications on weight gain and BMI increase should be taken into consideration by clinicians.

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Section: Resultsmentioning

confidence: 99%

Antipsychotic-Induced Weight Gain in First-Episode Psychosis Patients: A Meta-Analysis of Differential Effects of Antipsychotic Medications

Tek

Küçükgöncü

Gülöksüz

et al. 2016

FOC

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“…In another study9, 30 patients of schizophrenia or schizophreniform disorder were randomized to receive clozapine or risperidone and the results showed that patients on clozapine adhered to their original treatment for a longer period than patients on risperidone. In our study also, only 6.6 per cent patients dropped out during six months of the study, and none was due to adverse effects of the drug.…”

Section: Discussionmentioning

confidence: 99%

“…Sanz-Fuentenebro and colleagues9 compared clozapine with risperidone in patients with first-episode psychosis and suggested that clozapine might have a slightly superior efficacy initially in the treatment of first-episode treatment naive patients with schizophrenia. No published data are available from India.…”

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confidence: 99%

Comparative study of clozapine versus risperidone in treatment-naive, first-episode schizophrenia: A pilot study

et al. 2016

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Background & objectives:Clozapine may be more useful in treatment-naive patients with first-episode schizophrenia for better symptoms control and improving quality of life. The current study was carried out to compare the efficacy and tolerability of clozapine versus risperidone in treatment-naive, first-episode patients of schizophrenia.Methods:This was a comparative, open-label, six months prospective study of treatment-naive, first-episode patients with schizophrenia between the age group of 18 and 40 yr diagnosed as per the International Classification of Diseases-10 (ICD-10) criteria. A total of 63 patients were recruited and randomly assigned to clozapine group or risperidone group using computer-generated random number tables. Eight patients were lost to follow up. The dosages of the respective drugs were kept in therapeutic range of 200-600 mg/day and 4-8 mg/day orally for clozapine and risperidone, respectively.Results:On general psychopathology score, after six months of intervention, clozapine led to 60.32 per cent mean reduction in Positive and Negative Syndrome Scale (PANSS) for Schizophrenia total score while risperidone led to 56.35 per cent mean reduction in PANSS total score, which meant more improvement with clozapine. Clozapine group was found to have significant improvement in quality of life (P = 0.04339). On Glasgow Antipsychotic Side-effect Scale, clozapine was superior to risperidone. The most common side effects observed in clozapine group were oversedation (78.96%) and dizziness (55.23%), and in risperidone group, common side effects were rigidity (62.36%), sedation (38.69%), tremors (65.69%) and menstrual irregularities in 80.25 per cent of female patients.Interpretation & conclusions:The findings of this preliminary study showed clozapine as a better choice than risperidone in terms of efficacy, tolerability and better quality of life in treatment-naive, first-episode schizophrenia. However, further studies need to be done on a larger group of patients to confirm the findings.

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“…Preliminary data suggest that clozapine is most effective in the initial year of treatment in first-episode treatment-naive patients with schizophrenia. 9) Thus, for a higher response rate, clozapine should be considered as a second-line rather than a third-line treatment. Further analysis of the risk-benefit ratio in terms of potential side effects and individual patient psychopathology is essential.…”

Section: Discussionmentioning

confidence: 99%

Successful Early Clozapine Trial in the Treatment of First-episode Schizophrenia: A Case Report

Kim

Lee

2013

Clin Psychopharmacol Neurosci

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Clozapine remains the treatment of choice in refractory schizophrenia despite its various requirement to prescribe, such as mandatory blood monitoring program and various metabolic complication. Currently, clozapine is recommended only after two failed adequate antipsychotics trials. We report a case of a successful early clozapine trial in the treatment of first-episode schizophrenia patient, considering poor treatment response and repeated self-injurious behavior. This case highlights the efficacy of an early clozapine trial as a second-line treatment for first-episode schizophrenia in contrast to switching or combination treatment strategy.

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Randomized trial of clozapine vs. risperidone in treatment-naïve first-episode schizophrenia: Results after one year

Cited by 32 publications

References 30 publications

Antipsychotic-Induced Weight Gain in First-Episode Psychosis Patients: A Meta-Analysis of Differential Effects of Antipsychotic Medications

Antipsychotic-Induced Weight Gain in First-Episode Psychosis Patients: A Meta-Analysis of Differential Effects of Antipsychotic Medications

Comparative study of clozapine versus risperidone in treatment-naive, first-episode schizophrenia: A pilot study

Successful Early Clozapine Trial in the Treatment of First-episode Schizophrenia: A Case Report

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