July 13, 2009
Anti-Psychotic Might Have Saved Thousands Of Schizophrenics
A Finnish research study suggests that thousands of people with schizophrenia worldwide could have been saved if doctors had prescribed them the anti-psychotic drug clozapine, The Associated Press reported.
Clozapine, which was introduced in the 1970s, was banned for a decade when studies showed that up to 2 percent of patients experienced agranulocytosis, a potentially fatal decline in white blood cells, while taking the drug.
It was the first of a new generation of schizophrenia drugs, known as atypical anti-psychotics, but concerns about the safety profile of all the atypical anti-psychotics have loomed large since 2002 after evidence of increased rates of diabetes and cardiovascular disease.
By the 1980s clozapine was back on the market with warning labels about its use, and is now sold generically as Clozaril, Leponex, Denzapine, Fazaclo, among other names.
However, guidelines in most developed countries recommend clozapine only as a last resort, if patients have already tried two other drugs but still aren't better.
Jari Tiihonen of the University of Kuopio in Finland and colleagues conducted a study examining the death rates of about 67,000 schizophrenic patients in Finland versus those of the general population between 1996 and 2006.
They found that patients on clozapine had the lowest risk of dying, compared to other patients with schizophrenia.
"There is now a case to be made for revising the guidelines to make clozapine available to a much larger proportion of patients," said James MacCabe, a consultant psychiatrist at the National Psychosis Unit at South London and Maudsley Hospital.
The researchers discovered that even though the use of anti-psychotic medications had jumped in the last decade, people with schizophrenia in Finland still died about two decades earlier than those from other countries.
Newer drugs including quetiapine, haloperidol and risperidone increased the death risk by 41 percent, 37 percent and 34 percent respectively, when compared to older drugs, the study showed.
Patients on clozapine, for instance, had a 26 percent lower chance of death.
The Finnish findings could be extrapolated to most other developed countries, according to experts. MacCabe suggested doctors might give their schizophrenic patients clozapine after trying one other drug, as opposed to two.
"Clozapine is particularly effective in reducing suicidal tendencies in schizophrenic patients, in whom suicides account for about 40 percent of unexpected deaths," said MacCabe.
Lydia Chwastiak of the department of psychiatry at Yale University, who was not connected to the research, said doctors should find ways to get more people on the medicine.
African-American patients in particular are treated less often with clozapine, according to a study at the University of Maryland.
Chwastiak said if clozapine can help people live longer, researchers need to look seriously at the barriers to using it.
"Clozapine's patent expired long ago, so there's no big money to be made from marketing it," said Tiihonen, who partly blamed the pharmaceutical industry for why clozapine has often been overlooked.
"We should consider whether clozapine should be used as a first-line treatment option," he said.
The full study, which was paid for by Finland's Ministry of Health and Welfare, was published online Monday in the medical journal Lancet.
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