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Switch From Oral Olanzapine to Depot Risperidone Safe, May Improve Symptoms: Presented at ECNP

By Paula Moyer

PRAGUE, CZECH REPULIC -- October 3, 2003 -- Patients with schizophrenia can switch safely from oral olanzapine to risperidone in a long-acting injectable formulation and experience some improvement of symptoms.

"Long-acting risperidone was well tolerated in patients [who] switched from oral olanzapine," said Robert Jones, MD, a researcher with the medical affairs department of Janssen Pharmaceutica, Titusville, New Jersey, United States. Dr. Jones noted that improvement seen following the switch may be due to poor compliance with the oral formulation. Janssen manufacturers risperidone under the tradename Risperdal®.

Dr. Jones and co-investigators analysed data obtained from a randomised, double-blind, parallel-group study that had been supported by Johnson & Johnson Pharmaceutical Research and Development. They presented their findings here at the 16^th Congress of the European College of Neuropsychopharmacology.

In the original research, patients had been switched from a variety of oral formulations of atypical antipsychotics to injectable risperidone or a placebo. The investigators conducted the current research to assess the effect of the depot formulation regarding symptom control and quality of life in comparison with prior treatment with oral olanzapine.

The group consisted of 16 patients who switched from olanzapine to placebo, and 42 who were switched from olanzapine to long-acting risperidone. The investigators confirmed that the total Positive and Negative Syndrome Scores (PANSS) and average olanzapine doses were comparable. PANSS-Total scores were a mean of 83.3 in the treatment group and 83.1 in the placebo arm. The mean olanzapine dose prior to the switch was 15.3 mg daily in the treatment arm and 16.0 mg daily in the placebo arm.

At the end of the study, the PANSS scores for the placebo group were more severe regarding the subscales of hostility/excitement, anxiety/depression, disorganized thoughts, negative symptoms and positive symptoms. In the treatment arm, the scores were less severe for all subscales. The average PANSS-Total score increased by 4.4 points in placebo patients and decreased by 6.9 points in treated patients (P=0.05 between groups).

Further, the patients in the treatment arm had PANSS-Total scores that were better than their scores while on olanzapine (P=0.027). The improvement was statistically significant in the Positive, Negative and Mood/Anxiety subscales (P<0.05). Patients in the depot risperidone arm also showed improvement in the Short Form-36 (SF-36) domain pertaining to social functioning as well as in the mental health index (P=0.053 and P=0.041, respectively).

The primary adverse effects that the investigators observed were movement disorders and injection-site pain. Dr. Jones noted that the severity level of movement disorders was mild at the onset of the study and continued to be mild throughout the study. Generally, Patients reported that injection-site pain was mild at the onset of the study and decreased through the course of the study.

The findings show that switching patients from oral olanzapine to long-acting risperidone can result in improvements in both symptoms and in quality of life, Dr. Jones said. He cautioned that the size of the study limited the implications that could be drawn from it, as well as the fact that the original study was not designed to compare any individual treatment to the study drug.


[Study title: Clinical Improvement With Long-Acting Risperidone in Patients Previously Receiving Oral Olanzapine. Abstract P.2.057]

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