New Generation Antipsychotic Drug Cuts Relapse Rate In Patients With Schizophrenia

Just under one percent of the general population suffers from schizophrenia. The economic burden of the disease was estimated at $33 billion per year in the early 1990s. Much of that cost can be attributed to the consequences of psychotic relapse, which is common among schizophrenic patients.

Past studies of antipsychotic drugs tended to be short-term trials, lasting four to eight weeks. They had shown that second-generation drugs helped reduce psychotic symptoms, but longer-term studies were needed in order to determine their long-term effects on the disorder, especially on relapse.

“Schizophrenia is a chronic, psychiatric illness,” explains John G. Csernansky, M.D., the Gregory B. Couch Professor of Psychiatry at Washington University School of Medicine in St. Louis and the study’s principal investigator. “Relapse is common even under the best of circumstances, with an average patient relapsing at least once every one to two years. Because of the chronic nature of the illness, it is very important to determine whether newer drugs can diminish the relapse rate. Relapse prevention is the most important indicator of therapeutic success over the long term.”

The study involved nearly 400 patients with schizophrenia. They were treated at 40 sites around the United States. All study patients had records of having relapsed within the 24 months prior to the start of the study. Investigators spent two years comparing the rate of relapse in patients taking risperidone, a second-generation antipsychotic medication, to patients taking an older drug, haloperidol. Since its discovery in the 1950s, haloperidol has been one of the most commonly prescribed drugs in patients with schizophrenia and other psychotic disorders.

“At the time this study began, haloperidol was the most commonly used antipsychotic drug in the United States,” says Csernansky. “In any way one could measure it, haloperidol was the industry standard.”

When the study was completed, Csernansky and colleagues found that the one-year rate of relapse for patients on haloperidol was about 50 percent. But the rate of relapse for patients taking risperidone was only about 25 percent, about half of what was observed in patients taking the older drug.

“Reducing the rate of relapse is a tremendous benefit to the patient, but it’s also a benefit for the family and the system of care that has to pay for the hospitalization that often goes along with relapse,” Csernansky says. “Most importantly, however, patients who relapse face many months of difficulty. Hospitalization can last from seven to 21 days, but even after discharge it may take weeks, if not months, to restore work relationships and social relationships a patient had established prior to relapse.”

Haloperidol and other traditional antipsychotic drugs block activ