Conventional and new-generation antipsychotics may have similar neurological side-effects

May 08, 2003

Authors 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."
-end-
Contact: Dr Stefan Leucht, The Zucker Hillside Hospital, 75-59 263rd St, Glen Oaks, New York 11004, USA;
T) 718-470-8524;
F) 718-343-7739;
E) Sleucht@lij.edu

Lancet

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