Zhang Cheng1, Yanbo Yuan1, Xue Han1, Lei Yang1, Shangli Cai2, Fude Yang3, Zheng Lu4, Chuanyue Wang5, Hong Deng6, Jingping Zhao2, Yutao Xiang7, Christoph U Correll8,9,10,11, Xin Yu1. 1. Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Centre for Mental Disorders (Peking University Sixth Hospital), Beijing, PR China. 2. Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha, PR China. 3. Beijing Hui-Long-Guan Hospital, Beijing, PR China. 4. Tongji Hospital of Tongji University, Shanghai, PR China. 5. Beijing Anding Hospital, Capital Medical University, Beijing, PR China. 6. West China Hospital, Sichuan University, Chengdu, PR China. 7. Unit of Psychiatry, Faculty of Health Science, University of Macau, Macao SAR, PR China. 8. The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA. 9. Hofstra Northwell School of Medicine, Hempstead, NY, USA. 10. Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany. 11. Investigator, Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA.
Abstract
PURPOSE: This study aimed to investigate the efficacy and tolerability of aripiprazole, olanzapine and risperidone in first-episode schizophrenia (FES). METHODS: The eight-week, open, randomised study was conducted in six Chinese medical centres. Altogether, 498 FES subjects were randomised to aripiprazole (n = 165), olanzapine (n = 168) or risperidone (n = 165). Efficacy was measured with the Positive and Negative Syndrome Scale (PANSS), tolerability with the Udvalg for Kliniske Undersogelser Side Effect Rating Scale (UKU) and functioning with the Personal and Social Performance Scale (PSP). RESULTS: All three antipsychotics significantly improved the baseline to end-point PANSS total and each of the sub-scale scores (p < 0.001). Risperidone was superior to olanzapine and aripiprazole regarding PANSS total end-point scores (p < 0.05). Cumulative response (PANSS total score reduction ⩾30%) was similar between risperidone, olanzapine and aripiprazole (74.8%, 73.5% and 70.1%; p = 0.707), but risperidone was superior to aripiprazole regarding PANSS total score reduction ⩾50% (37.8% vs. 26.6%; p < 0.05). Olanzapine was associated with the largest weight gain at week 4 and 8 (p < 0.01), weight gain ⩾7% (olanzapine = 49.0% vs. risperidone = 32.5% vs. aripiprazole = 17.0%; p < 0.01), more psychic side effects at week 8 (p < 0.01 each) and more 'other' side effects at week 4 (p < 0.001) and week 8 (p < 0.05) but fewer neurological side effects at week 4 (p < 0.05) and week 8 (p < 0.01). PSP improved more with risperidone than with aripiprazole at week 4 and 8 (p < 0.05). CONCLUSIONS: For FES, risperidone might be a better choice than aripiprazole due to improved efficacy and functional improvement, without inferior tolerability. Aripiprazole is a better choice to avoid relevant short-term weight gain. Olanzapine could be chosen to avoid neurological adverse effects.
RCT Entities:
PURPOSE: This study aimed to investigate the efficacy and tolerability of aripiprazole, olanzapine and risperidone in first-episode schizophrenia (FES). METHODS: The eight-week, open, randomised study was conducted in six Chinese medical centres. Altogether, 498 FES subjects were randomised to aripiprazole (n = 165), olanzapine (n = 168) or risperidone (n = 165). Efficacy was measured with the Positive and Negative Syndrome Scale (PANSS), tolerability with the Udvalg for Kliniske Undersogelser Side Effect Rating Scale (UKU) and functioning with the Personal and Social Performance Scale (PSP). RESULTS: All three antipsychotics significantly improved the baseline to end-point PANSS total and each of the sub-scale scores (p < 0.001). Risperidone was superior to olanzapine and aripiprazole regarding PANSS total end-point scores (p < 0.05). Cumulative response (PANSS total score reduction ⩾30%) was similar between risperidone, olanzapine and aripiprazole (74.8%, 73.5% and 70.1%; p = 0.707), but risperidone was superior to aripiprazole regarding PANSS total score reduction ⩾50% (37.8% vs. 26.6%; p < 0.05). Olanzapine was associated with the largest weight gain at week 4 and 8 (p < 0.01), weight gain ⩾7% (olanzapine = 49.0% vs. risperidone = 32.5% vs. aripiprazole = 17.0%; p < 0.01), more psychic side effects at week 8 (p < 0.01 each) and more 'other' side effects at week 4 (p < 0.001) and week 8 (p < 0.05) but fewer neurological side effects at week 4 (p < 0.05) and week 8 (p < 0.01). PSP improved more with risperidone than with aripiprazole at week 4 and 8 (p < 0.05). CONCLUSIONS: For FES, risperidone might be a better choice than aripiprazole due to improved efficacy and functional improvement, without inferior tolerability. Aripiprazole is a better choice to avoid relevant short-term weight gain. Olanzapine could be chosen to avoid neurological adverse effects.
Authors: David D Kim; Alasdair M Barr; Lulu Lian; Jessica W Y Yuen; Diane Fredrikson; William G Honer; Allen E Thornton; Ric M Procyshyn Journal: NPJ Schizophr Date: 2021-05-25
Authors: Paula Soria-Chacartegui; Gonzalo Villapalos-García; Pablo Zubiaur; Francisco Abad-Santos; Dora Koller Journal: Front Pharmacol Date: 2021-07-14 Impact factor: 5.810