Newer Antipsychotics No Better Than Older Ones in Treating Child, Adolescent Schizophrenia

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Title: Newer Antipsychotics No Better Than Older Ones in Treating Child, Adolescent Schizophrenia
URL: http://www.pslgroup.com/dg/22C5F6.htm
Doctor's Guide
September 15, 2008

BETHESDA, Md -- September 15, 2008 -- Two newer atypical antipsychotic medications were no more effective than an older conventional antipsychotic in treating child and adolescent schizophrenia, and may lead to more metabolic side effects, according to a new study published online in the American Journal of Psychiatry.

"Schizophrenia and schizophrenia-related disorders are rare in childhood. But when they do occur, those afflicted generally have more severe symptoms and a worse prognosis than those who develop the disorder in adulthood," said Thomas R. Insel, MD, National Institute of Mental Health (NIMH), Bethesda, Maryland.

"The newer atypical antipsychotics are often used to treat these children, but until now, it has been unclear how effective and safe they really are in children. The side effects of the newer medications should be factored into making treatment decisions."

The 6-year, multisite Treatment of Early Onset Schizophrenia Study (TEOSS) included 116 youth aged 8 and 19 years old, diagnosed with early onset schizophrenia spectrum disorder (EOSS).

The TEOSS team randomly assigned the children to 8 weeks of either olanzapine (Zyprexa) or risperidone (Risperdal) or to the older conventional antipsychotic molindone (Moban) plus benztropine. The children were monitored throughout the study by an NIMH oversight board to ensure their safety.

Response rates after 8 weeks of treatment were comparable among the 3 medications. Of the children taking molindone, 50% improved, while 46% of the children taking risperidone and 34% taking olanzapine improved.

Children taking olanzapine or risperidone improved within the first 2 weeks, while the children on molindone improved within 3 weeks.

The treatment groups did differ in side effects. The children taking olanzapine gained about 13 lbs (6 kg) during the trial on average, while children taking risperidone gained about 8 lbs (3.6 kg), and those taking molindone did not gain weight.

The olanzapine group also showed increases in cholesterol levels and other metabolic disruptions that may have become dangerous. The outcome prompted the safety review board to end the olanzapine arm of the study in 2006.

"Atypical antipsychotics are commonly used to treat kids with EOSS, but these results question the wisdom of that approach," said lead author Linmarie Sikich, MD, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

"They also remind us that we need to develop safer, more effective medications to treat these children, given the limited effectiveness of both the atypical and the conventional medications."

Study coauthor Jeffery Lieberman, MD, Columbia University Medical Center, New York, New York, noted that TEOSS is the first documented evidence of how newer antipsychotics compare to older ones when treating children and adolescents with schizophrenia.

"Doctors need to educate families about the potentially serious side effects these drugs can have so that strategies can be put into place to address them," he said.

SOURCE: National Institutes of Health

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