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Title: No Difference In Remission Of Manic Episodes In Bipolar Patients Taking Olanzapine Or Haloperidol

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Archives of General Psychiatry 2003;60:1218-1226.
12/11/2003 09:07:00 AM
By Elda Hauschildt

Olanzapine does not differ from haloperidol in overall remission of acute manic episodes in bipolar 1 patients, an international study indicates. Rates of remission were comparable in patients taking either drug, say researchers led by Dr. Mauricio Tohen of McLean Hospital in Belmont, Massachusetts, United States. However, patients treated with haloperidol had higher rates of extrapyramidal symptoms and those treated with olanzapine had higher weight gains. The researchers compared flexible dosing of the 2 drugs in 234 patients treated with olanzapine and 219 patients treated with haloperidol. Participants in the 12-week, randomised, double-bind, parallel-group study came from 58 centres in Western Europe, South Africa, North America and South America. Before randomisation, patients underwent 2 to 7 days of screening. Psychotropic medications other than benzodiazepines were tapered at least 1 day before the patients were randomised. Patients underwent double-blind, short-term therapy in the first 6-week phase of the trial, and double-blind continuation therapy in the second 6-week phase. Those who demonstrated at least a 1-point improvement in the Clinical Global Impressions-Severity of Bipolar Disorder scale entered the continuation phase. Rates of remission using the Young-Mania Rating Scale and Hamilton Rating Scale for Depression were similar for patients taking olanzapine (52.1%) and those taking haloperidol (46.1%). A subgroup of patients had index episodes that did not include psychotic features. In these patients, remission rates were significantly greater for olanzapine-treated patients (56.7%) than for haloperidol-treated patients (41.6%). Relapse into mania and/or depression was seen in 13.1% of olanzapine patients and 14.8% of haloperidol patients. Olanzapine seems to offer greater efficacy in patients who do not have psychotic episodes and has a lower risk of acute extrapyramidal symptoms, the researchers say. Haloperidol-treated patients experienced greater reduction in manic symptoms by week 6, but they also switched into depression more quickly. "The treating clinician should determine the appropriate therapy for an individual patient based on a risk-benefit assessment of the pharmacotherapy," the investigators suggest.

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