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Nevertheless, meta-analyses 6, 7 have raised questions about the size and significance of these effects. Claims of superiority for SGAs in terms of the treatment of negative symptoms, cognitive enhancement, fewer EPSs, and improved subjective experience and tolerability 5 have led to a general shift away from FGAs in the treatment of schizophrenia. Two systematic reviews 2, 3 showed that the 2 groups of drugs are generally equivalent in terms of efficacy against positive symptoms, whereas another study 4 found evidence of superiority for SGAs. Therapeutic differences between the other SGAs and FGAs are less certain. The first atypical drug, clozapine, is the most efficacious of all antipsychotics but is restricted to treatment-resistant schizophrenia because of adverse effects. 1Ītypical or second-generation antipsychotics (SGAs) were hailed as a major advance, principally because of their lower liability for EPSs. However, many people with schizophrenia receiving typical or first-generation antipsychotics (FGAs) have had a suboptimal outcome, with symptomatic relapses and disabling adverse effects, particularly sedation and extrapyramidal symptoms (EPSs). Neither inadequate power nor patterns of drug discontinuation accounted for the result.Īntipsychotic drugs have been the mainstay of schizophrenia treatment for almost 50 years. Participants reported no clear preference for either drug group costs were similar.Ĭonclusions In people with schizophrenia whose medication is changed for clinical reasons, there is no disadvantage across 1 year in terms of quality of life, symptoms, or associated costs of care in using FGAs rather than nonclozapine SGAs. Participants in the FGA arm showed a trend toward greater improvements in Quality of Life Scale and symptom scores. Results The primary hypothesis of significant improvement in Quality of Life Scale scores during the year after commencement of SGAs vs FGAs was excluded. Main Outcome Measures Quality of Life Scale scores, symptoms, adverse effects, participant satisfaction, and costs of care. Interventions Randomized prescription of either FGAs or SGAs (other than clozapine), with the choice of individual drug made by the managing psychiatrist. Participants Two hundred twenty-seven people aged 18 to 65 years with DSM-IV schizophrenia and related disorders assessed for medication review because of inadequate response or adverse effects.
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Setting Fourteen community psychiatric services in the English National Health Service.
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Objective To test the hypothesis that in people with schizophrenia requiring a change in treatment, SGAs other than clozapine are associated with improved quality of life across 1 year compared with FGAs.ĭesign A noncommercially funded, pragmatic, multisite, randomized controlled trial of antipsychotic drug classes, with blind assessments at 12, 26, and 56 weeks using intention-to-treat analysis. Most evidence comes from short-term efficacy trials of symptoms.
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