Leo Sher, M.D.
Ten years ago, a seminal research report, “Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial” was published in a 2008 issue of The Lancet (1). A large international group of research collaborators led by Professor Rene S. Kahn compared the effectiveness of second-generation antipsychotic drugs with that of a low dose of haloperidol.
This controlled trial of haloperidol versus second-generation antipsychotic drugs was conducted in 50 sites, of which 36 were university hospitals, in 14 countries: Austria, Belgium, Bulgaria, Czech Republic, France, Germany, Israel, Italy, Netherlands, Poland, Romania, Spain, Sweden, and Switzerland. 498 patients aged 18–40 years and who met DSM-IV criteria for schizophrenia, schizophreniform disorder, or schizoaffective disorder were included in the study. Patients were excluded if more than 2 years had passed since the beginning of positive symptoms; if any antipsychotic medication had been used for more than 2 weeks in the previous year, or for 6 weeks at any time. Study participants were randomly assigned to daily doses of: haloperidol 1–4 mg, amisulpride 200–800 mg, olanzapine 5–20 mg, quetiapine 200–750 mg, or ziprasidone 40–160 mg.
This research study has shown that in patients with first-episode schizophrenia and schizophreniform disorder, treatment discontinuation after 12 months was significantly larger in patients given a low dose of haloperidol than in study participants assigned to treatment with second-generation antipsychotic medications. Researchers found that symptom reductions were virtually the same in all 5 groups, at around 60%. The authors concluded that “although the high continuation rates for several of the second-generation antipsychotic drugs suggest that clinically meaningful long-term antipsychotic treatment is achievable in the first-episode of schizophrenia, it cannot be concluded that second-generation antipsychotic drugs are more efficacious than is haloperidol in the treatment of these patients.”
- Kahn RS, Fleischhacker WW, Boter H, Davidson M, Vergouwe Y, Keet IP, Gheorghe MD, Rybakowski JK, Galderisi S, Libiger J, Hummer M, Dollfus S, López-Ibor JJ, Hranov LG, Gaebel W, Peuskens J, Lindefors N, Riecher-Rössler A, Grobbee DE; EUFEST study group.Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial. Lancet. 2008;371(9618):1085-97. doi: 10.1016/S0140-6736(08)60486-9.