Schizophrenia Bulletin Advance Access originally published online on October 5, 2007
Schizophrenia Bulletin 2007 33(6):1274-1276; doi:10.1093/schbul/sbm101
© The Author 2007. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org.
Risperidone Versus Olanzapine for Treatment of Schizophrenia
Mahesh B. Jayaram1,2,
Prakash M. Hosalli3 and
Thomas S. Stroup4
2 Leeds Mental Health Trust, Bridge House, Balm Road, Leeds LS10 2TP, UK
3 Leeds Mental Health Trust, Newsam Centre, Seacroft, Leeds LS14 6WB, UK
4 Department of Psychiatry, University of North Carolina at Chapel Hill, CB# 7160, Chapel Hill, NC 27599-7160
Keywords: risperidone / olanzapine / schizophrenia / systematic review / meta-analysis
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Background
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Antipsychotic medication is a mainstay of treatment for schizophrenia.
Risperidone and olanzapine are popular choices among the new
generation drugs.
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Objectives
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To determine the clinical effects, safety and cost effectiveness
of risperidone were compared with those of olanzapine for treating
schizophrenia.
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Search Strategy
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We searched the Cochrane Schizophrenia Group's Register (September
2005), and references of all identified studies were inspected
for further trials. We also contacted relevant pharmaceutical
companies for additional information.
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Selection Criteria
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We included all clinical randomized trials comparing risperidone
with olanzapine for schizophrenia and schizophrenia-like psychoses.
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Data Collection and Analysis
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We extracted data independently. For homogenous dichotomous
data, we calculated random effects, relative risk (RR), 95%
confidence intervals (CIs), and, where appropriate, numbers
needed to treat/harm (NNT/H) on an intention-to-treat basis.
For continuous data, we calculated weighted mean differences.
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Main Results
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We found no difference for the outcome of unchanged or worse
in the short term (
n = 548, 2 randomized control trial (RCTs),
RR = 1.00, 95% CI = 0.88 to 1.15). One study favored olanzapine
for the outcome of relapse/rehospitalization by 12 months (
n = 279, 1 RCT, RR = 2.16, 95% CI = 1.31 to 3.54, NNH = 7, 95%
CI = 3 to 25). Most mental state data showed the 2 drugs to
be as effective as each other (
n = 552, 2 RCTs, RR ‘no
<20% decrease Positive and Negative Syndrome Scale by 8 weeks’
1.00, 95% CI = 0.87 to 1.15) (Figure 1). Both drugs commonly
cause adverse events: 75% given either drug experienced an adverse
event; 20% experienced anticholinergic symptoms; both groups
experienced insomnia although it was more frequent with risperidone
(
n = 1588, 5 RCTs, RR = 1.41, 95% CI = 1.15 to 1.72, NNH = 15,
95% CI = 9 to 41); and about 30% experienced sleepiness (
n =
1713, 6 RCTs, RR = 0.92, 95% CI = 0.79 to 1.07). People given
either drug often experienced extrapyramidal symptoms (
n = 893,
3 RCTs, RR = 1.18, 95% CI = 0.75 to 1.88); 25% of people using
risperidone and 18% of people using olanzapine required medication
to alleviate these symptoms (
n = 419, 2 RCTs, RR = 1.76, 95%
CI = 1.25 to 2.48, NNH = 8, 95% CI = 4 to 25). People allocated
to risperidone (13%) were less likely to gain more than 7% of
their baseline weight compared with those given olanzapine (28%),
and the weight gain was often considerable and of quick onset
(
n = 984, 2 RCTs, RR gain more than 7% of their baseline weight
in the short term 0.47 95% CI = 0.36 to 0.61, NNH = 7, 95% CI
= 6 to 10). Risperidone participants were less likely to leave
the study due to metabolic side effects and weight gain compared
with olanzapine participants (
n = 667, 1 RCT, RR = 0.19, 95%
CI = 0.08 to 0.45). Patients on risperidone were more likely
to experience abnormal ejaculation (
n = 370, 2 RCTs, RR = 4.36,
95% CI = 1.38 to 13.76, NNH = 20, 95% CI = 6 to 176). Both drugs
are associated with high attrition rates; in the long term,
66% of those allocated risperidone left the study early compared
with 56% given olanzapine (
n = 1440, 5 RCTs, RR = 1.17, 95%
CI = 1.08 to 1.27, NNH = 11, 95% CI = 7 to 23) (Figure 2).
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Conclusions
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We know very little of the effects of these drugs regarding
service outcomes, general functioning and behaviors, engagement
with services, and treatment satisfaction from randomized trials.
In the studies, attrition rates are high and there appears to
be little to differentiate between risperidone and olanzapine
except on issues of their different but frequent, unpleasant
adverse effects. The full version of this review is available
on the Cochrane Library.
1
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Footnotes |
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1 To whom correspondence should be addressed; tel: +44-113-3058302, fax: +44-113-277-2830, e-mail: maheshbj{at}gmail.com.
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Acknowledgments
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Jayaram and Hosalli have attended meetings sponsored by Janssen
and Eli Lilly. Stroup has consulted for Janssen and Eli Lilly
and has received research funding from Eli Lilly. He was a coprincipal
investigator in the Clinical Antipsychotic Trials in Intervention
Effectiveness 2005 study.
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References
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Jayaram MB, Hosalli P, Stroup S. Risperidone versus olanzapine for schizophrenia. Cochrane Database Syst Rev (2006) (2). CD005237.
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Background
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