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New-generation Antipsychotic Drugs May Have Similar Neurological Side-effects To Conventional Drugs (p 1581)
May 07, 2003Authors of a systematic review of antipsychotic drugs in this week's issue of THE LANCET highlight how the better side-effect profile of new-generation drugs may not be as substantial as previously thought when compared with conventional antipsychotics.
New-generation drugs are generally more efficacious, although older-generation antipsychotics are still a cost-effective option for treating disorders such as schizophrenia in resource-poor settings.
The main advantage of new-generation antipsychotic drugs is a reduced risk of side-effects compared with conventional drugs. However, there is debate that the reduced side-effects of the new-generation class of drugs is based on trials that could have been biased due to comparisons with the high-potency antipsychotic drug haloperidol.
Stefan Leucht from the Zucker Hillside Hospital, New York, USA, and colleagues reanalysed all previous randomised controlled trials where new-generation antipsychotics had been compared with low-potency conventional drugs.
31 studies which involved 2320 patients were identified. Of the new generation drugs, only clozapine was associated with fewer neurological side-effects and higher efficacy than low-potency conventional drugs. As a group, new-generation drugs were moderately more efficacious than low-potency antipsychotics.
Stefan Leucht comments: "Optimum doses of low-potency conventional antipsychotics might not induce more neurological side-effects than new generation drugs. Potential advantages in efficacy of the new-generation drugs should be a factor in clinical treatment decisions to use these rather than conventional drugs. However, if these findings are confirmed by future studies, there would be a good argument for the use of appropriately dosed conventional drugs-such as chlorpromazine-for patients with schizophrenia in settings where new-generation drugs are not generally affordable."
Lancet
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