Which Schizophrenia Drug Gets Top Marks?

Coming just one month after an extensive review article on Cognitive Behavior Therapy for Schizophrenia, the American Journal of Psychiatry has published the results of a federally-funded study offering a head-to-head comparison of drugs for treating schizophrenia.

The drug Clozaril (clozapine) emerged as more effective than Risperdal, Seroquel and Zyprexa, according to lead author Dr. Joseph McEvoy of the Duke University Medical Center. The study asked the following question: If the first drug a patient tries fails to control symptoms adequately, what drug should be tried next? When randomly assigned a drug from the list above in the new study, Clozaril came out on top.

In a press release carried by the APA’s PsycPort, McEvoy is quoted:

That’s not a surprise, he said, because Clozaril “was believed to be the most therapeutically effective drug out there.” But it’s under-used because of the risk of side effects that require patients to go through special monitoring, he said.

In a companion analysis of other patients who didn’t want to try Clozaril or who’d abandoned their first medication because of side effects, Risperdal and Zyprexa were found to be more effective than Geodon and Seroquel.

The press release goes on:

Dr. Darrel Regier, director of the research division of the American Psychiatric Association, said the head-to-head drug comparisons are “a major step forward” that will help doctors make a choice for a second drug to try. Doctors have to consider both effectiveness and side effects of the various drugs in deciding what’s best for each patient, he said.

In fact, McEvoy said if a patient had gotten inadequate response from a first drug other than Zyprexa, he’d recommend trying Zyprexa because it doesn’t have Clozaril’s side effects and the need for special monitoring of patients. But if Zyprexa doesn’t work, he said, he’d recommend Clozaril.

Clozaril’s potential side effects include a loss of disease-fighting white blood cells and a potentially fatal inflammation of heart muscle. The risks make it more complex to use because patients must be closely monitored. For example, users must take weekly blood tests at first.

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