Clinical and economic outcomes of risperidone versus clozapine in the treatment of chronic schizophrenia

T. H. Dhanya; Reneega Gangadhar; N. Subha

doi:10.18203/2319-2003.ijbcp20151335

Authors

T. H. Dhanya Department of Pharmacology, Government Medical College,Thrissur,Kerala,India
Reneega Gangadhar Department of Pharmacology, Sree Mookambika Institute of Medical Sciences, Kulashekaram, Kanyakumari, Tamil Nadu, India
N. Subha Department of Psychiatry, Sree Gokulam Medical College and Research Foundation,Venjaramoodu, Trivandrum, Kerala, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20151335

Keywords:

Atypical antipsychotics, Pharmacoeconomics, Adverse drug reactions

Abstract

Background: The purpose of this study was to examine clinical outcomes and direct cost associated with risperidone and clozapine for the treatment of chronic schizophrenia.

Methods: In a prospective observational study on 100 patients with schizophrenia in a tertiary care setting clinical outcome was measured using positive and negative syndrome scale (PANSS) and costs by direct medical cost.

Results: Both risperidone and clozapine significantly reduced the severity of psychotic symptoms (scores on the PANSS) from baseline, with no significant between group differences. The clinical improvement was more in the case of clozapine compared to risperidone group (p=0.479). In both groups, extrapyramidal symptoms and other adverse events were few, and their severity was generally mild. A statistical significance was noted in the total direct cost which was higher in patients receiving clozapine when compared to risperidone.

Conclusions: Risperidone was well tolerated and as effective as clozapine in patients with chronic schizophrenia and more economical than clozapine.

Metrics

Metrics Loading ...

References

Where next with psychiatric illness? Nature. 1988;336(6195):95-6.

Tandon R, Jibson MD. Efficacy of newer generation antipsychotics in the treatment of schizophrenia. Psychoneuroendocrinology. 2003;28 Suppl 1:9-26.

Lehman AF, Lieberman JA, Dixon LB, McGlashan TH, Miller AL, Perkins DO, et al. Practice guideline for the treatment of patients with schizophrenia, second edition. Am J Psychiatry. 2004;161 2 Suppl:1-56.

Tuunainen A, Wahlbeck K, Gilbody SM. Newer atypical antipsychotic medication versus clozapine for schizophrenia. Cochrane Database Syst Rev. 2000;(2):CD000966.

Grant S, Fitton A. Risperidone. A review of its pharmacology and therapeutic potential in the treatment of schizophrenia. Drugs. 1994;48(2):253-73.

Meltzer HY. An overview of the mechanism of action of clozapine. J Clin Psychiatry. 1994;55 Suppl B:47-52.

Leysen JE, Janssen PM, Megens AA, Schotte A. Risperidone: a novel antipsychotic with balanced serotonin-dopamine antagonism, receptor occupancy profile, and pharmacologic activity. J Clin Psychiatry. 1994;55 Suppl:5-12.

Sadock BJ, Sadock VA. Schizophrenia. In: Kaplan HI, Sadock BJ, editors. Synopsis of Psychiatry: behavioral Sciences/Clinical Psychiatry. 10th Edition. New York: Lippincott Williams and Wilkins; 2007: 469.

Bondolfi G, Dufour H, Patris M, May JP, Billeter U, Eap CB, et al. Risperidone versus clozapine in treatment-resistant chronic schizophrenia: a randomized double-blind study. The Risperidone Study Group. Am J Psychiatry. 1998;155(4):499-504.

Ali RM, Bhatti RS. Social support system and family burden due to chronic schizophrenia in rural and urban background. Indian J Psychiatry. 1988;30(4):349-53.

Grover S, Avasthi A, Chakrabrty S, Kulahara P. Cost of illness of schizophrenia: overview and emerging trends. Indian J Psychiatry. 2005;47:205-17.

Carney CP, Jones L, Woolson RF. Medical comorbidity in women and men with schizophrenia: a population-based controlled study. J Gen Intern Med. 2006;21(11):1133-7.

Rosenheck R, Cramer J, Xu W, Grabowski J, Douyon R, Thomas J, et al. Multiple outcome assessment in a study of the cost-effectiveness of clozapine in the treatment of refractory schizophrenia. Department of Veterans Affairs Cooperative Study Group on Clozapine in Refractory Schizophrenia. Health Serv Res. 1998;33:1237-61.

Rosenheck R, Cramer J, Allan E, Erdos J, Frisman LK, Xu W, et al. Cost-effectiveness of clozapine in patients with high and low levels of hospital use. Department of Veterans Affairs Cooperative Study Group on Clozapine in Refractory Schizophrenia. Arch Gen Psychiatry. 1999;56(6):565-72.

Lewis SW, Barnes TR, Davies L, Murray RM, Dunn G, Hayhurst KP, et al. Randomized controlled trial of effect of prescription of clozapine versus other second-generation antipsychotic drugs in resistant schizophrenia. Schizophr Bull. 2006;32(4):715-23.

McEvoy JP, Lieberman JA, Stroup TS, Davis SM, Meltzer HY, Rosenheck RA, et al. Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. Am J Psychiatry. 2006;163(4):600-10.

Krishnan S. An open clinical trial with risperidone in chronic schizophrenia. Indian J Psychiatry. 1999;41:51.

Almond S, Knapp M, Francois C, Toumi M, Brugha T. Relapse in schizophrenia: costs, clinical outcomes and quality of life. Br J Psychiatry. 2004;184:346-51.

Breier AF, Malhotra AK, Su TP, Pinals DA, Elman I, Adler CM, et al. Clozapine and risperidone in chronic schizophrenia: effects on symptoms, parkinsonian side effects, and neuroendocrine response. Am J Psychiatry. 1999;156(2):294-8.