Antipsychotic Treatment Effectiveness in First Episode of Psychosis: PAFIP 3-Year Follow-Up Randomized Clinical Trials Comparing Haloperidol, Olanzapine, Risperidone, Aripiprazole, Quetiapine, and Ziprasidone
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Identificadores
URI: http://hdl.handle.net/10902/21819DOI: 10.1093/ijnp/pyaa004
ISSN: 1461-1457
ISSN: 1469-5111
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Gómez Revuelta, Marcos; Pelayo Terán, José María; Juncal Ruiz, María; Vázquez Bourgon, Javier; Suárez Pinilla, Paula; Romero Jiménez, Rodrigo; Setién Suero, María Esther; Ayesa Arriola, Rosa; Crespo Facorro, BenedictoFecha
2020-01-24Derechos
Attribution-NonCommercial 4.0 International
Publicado en
International Journal of Neuropsychopharmacology (2020) 23(4): 217-229
Editorial
Oxford University Press
Enlace a la publicación
Palabras clave
Schizophrenia
Antipsychotics
First-episode-psychosis
Resumen/Abstract
Background:
Different effectiveness profiles among antipsychotics may be a key point to optimize treatment in patients suffering a first episode of psychosis to impact on long-term outcome. The aim of this study is to compare the clinical effectiveness of olanzapine, risperidone, haloperidol, aripiprazole, ziprasidone, and quetiapine in the treatment of first episode of psychosis at 3-year follow-up.
Method:
From February 2001 to January 2011, 2 phases of a prospective, randomized, open-label study were undertaken. A total of 376 first-episode drug-naïve patients were randomly assigned to olanzapine (n=55), risperidone (n=63), haloperidol (n=56), aripiprazole (n=78), ziprasidone (n=62), or quetiapine (n=62) and followed up for 3 years. The primary effectiveness measure was all cause of treatment discontinuation. In addition, an analysis based on intention-to-treat principle was conducted in the analysis for clinical efficacy.
Results:
The overall dropout rate at 3 years reached 20.75%. Treatment discontinuation rates were significantly different among treatment groups (olanzapine=69.09, risperidone=71.43, aripiprazole=73.08%, ziprasidone=79.03%, haloperidol=89.28%, and quetiapine=95.53%) (x2=79.86; P=.000). Statistically significant differences in terms of lack of efficacy, adherence, and tolerability were observed among treatment groups along the 3-year follow-up, determining significant differences in time to all-cause discontinuation (log-rank=92.240; P=.000). Significant differences between treatments were found in the categories of sleepiness/sedation, increased sleep duration, akinesia, weight gain, ejaculatory dysfunction, extrapyramidal-symptoms, and amenorrhea.
Conclusions:
Olanzapine, risperidone, and aripiprazole presented advantages for the first-line treatment of first episode of psychosis in terms of effectiveness. Identifying different discontinuation patterns may contribute to optimize treatment selection after first episode of psychosis.
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