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Risperidone, Clozapine Seem Equally Effective In Refractory Schizophrenia

A new analysis by Finnish psychiatrists corroborates previous findings that risperidone may be as effective as clozapine in treatment-resistant schizophrenia.

This underlines the need for a full-scale multi-centre, randomised pragmatic trial with sufficient power to detect differences between the two treatments, they say.

Clozapine, a dibenzodiazepine agent with low potential for producing extrapyramidal effects, is the current treatment of choice for refractory schizophrenia. But the atypical antipsychotic, risperidone, a benzisoxazole derivative with potentially fewer extrapyramidal side effects, may be an alternative, the researchers suggest.

In a pilot trial to compare the effectiveness of the two agents in everyday practice and to assess the feasibility of a pragmatic trial, they studied 19 patients randomly assigned to open-label clozapine or risperidone for 10 weeks. Treatment outcomes were assessed blindly.

Five of the 10 participants given clozapine and one of the nine who received risperidone dropped out before the study was completed. But there was clinical improvement -- defined as a 20 percent fall in Positive and Negative Symptom Scale total score -- in five clozapine patients and six risperidone patients.

There were no significant differences between the groups in baseline or end point-positive or -negative symptoms, disease severity, or global or social functioning scores. Nor did the two groups of patients differ in their opinions of the drugs.
"Risperidone Versus Clozapine in Treatment-Resistant Schizophrenia: A Randomized Pilot Study"

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