Older Drug May Be More Cost Effective for Some Patients With Schizophrenia
In modern popular culture, we're often led to believe that "newer" automatically translates to "better." But that is not always the case, even in the world of medicine.
Schmalfeldt: In modern popular culture, we're often led to believe that "newer" automatically translates to "better." But that is not always the case, even in the world of medicine. For example, a new study shows that an older, or first generation, drug called perphenazine was less expensive and no less effective than the newer, second generation antipsychotic medications used to treat schizophrenia. This suggests that the older antipsychotic medications still have a role in treating this condition, according to Dr. Philip Wang, director of the Division of Services and Intervention Research at the National Institute of Mental Health, which funded the study.
Wang: It turns out, despite what had been the thought in the field, the older drug actually cost less and was no less effective. So the bottom line is, unlike what people believed which was that first generation drugs should be kind of reserved as a second line treatment, they actually look like they are very plausible first line treatments.
Schmalfeldt: Dr. Wang was quick to point out that this does not mean that doctors treating patients with the newer, second generation drugs should automatically switch their patients to the older, less expensive medication.
Wang: What it just means is that, unlike what people had been thinking — which is that these second generation drugs should just be used no matter what — it means that the older drugs still probably have a place and we shouldn't forget to consider them in treating patients with schizophrenia.
Schmalfeldt: The findings echo what was implied in the results of the first phase of the Clinical Antipsychotic Trials of Intervention Effectiveness, otherwise known as the CATIE trial, expanding treatment options for patients with schizophrenia. It casts doubts on the notion that the second generation antipsychotics are better than the first generation medications, and suggests that perphenazine and the other first generation antipsychotics may be just as beneficial for some patients. However, some conditions of the trial limit any firm conclusions about perphenazine's perceived advantages. For one thing, not all patients respond the same to different medications. And although the study lasted 18 months, which is long enough to determine how patients respond to and initially tolerate the drugs, it wasn't long enough to consider some serious, long-term potential side effects. The study results were published in the December 1st issue of the American Journal of Psychiatry. From the National Institutes of Health, I'm Bill Schmalfeldt in Bethesda, Maryland.
About This Audio Report
Reporter: Bill Schmalfeldt
Sound Bite: Dr. Philip Wang
Topic: Psychiatry, Medications