The British Journal of Psychiatry (2008) 193: 279-288. doi: 10.1192/bjp.bp.108.050088
© 2008 The Royal College of Psychiatrists
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Extrapyramidal side-effects of antipsychotics in a randomised trial

Del D. Miller, PharmD, MD

University of Iowa Carver College of Medicine, Iowa City, Iowa

Stanley N. Caroff, MD

University of Pennsylvania School of Medicine and the Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania

Sonia M. Davis, DrPH

Quintiles Inc, North Carolina

Robert A. Rosenheck, MD

Yale University School of Medicine, West Haven, Connecticut

Joseph P. McEvoy, MD

Duke University Medical Center, Durham, North Carolina

Bruce L. Saltz, MD

Mental Health Advocates, Inc, Boca Raton, Florida

Silvana Riggio, MD

Mount Sinai School of Medicine-James J. Peter VAMC, Bronx, New York

Miranda H. Chakos, MD

State University of New York Downstate Medical Center, Brooklyn, New York

Marvin S. Swartz, MD

Duke University Medical Center, Durham, North Carolina

Richard S. E. Keefe, PhD and T. Scott Stroup, MD, MPH

North Carolina School of Medicine, Neurosciences Hospital, Chapel Hill, North Carolina

Jeffrey A. Lieberman, MD

Columbia University College of Physicians and Surgeons, New York, New York, USA

the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Investigators

Correspondence: Del D. Miller, University of Iowa Carver College of Medicine, Psychiatry Research, #2-105 MEB, 500 Newton Road, Iowa City, IA 52242–1000, USA. Email: del-miller{at}uiowa.edu

Declaration of interest

AstraZeneca Pharmaceuticals, Bristol-Myers Squibb, Forest Pharmaceuticals Inc, Janssen Pharmaceutica, Eli Lilly & Co, Otsuka Pharmaceutical Co, Ltd, Pfizer Inc, and Zenith Goldline Pharmaceuticals provided medications for the study. Authors declare receipt of funding and/or fees from the following (details in Acknowledgements): AstraZeneca Pharmaceuticals (D.D.M., R.A.R., J.P.McE., B.L.S., M.H.C., M.S.S., R.S.E.K., J.A.L.); Bristol-Myers Squibb (D.D.M., S.N.C., R.A.R., J.P.McE., M.S.S., R.S.E.K., T.S.S., J.A.L.); Eli Lilly & Co (R.A.R., J.P.McE., M.S.S., R.S.E.K., T.S.S., J.A.L.); Forest Laboratories (R.S.E.K.); Forest Pharmaceutical Co (J.A.L.); Forest Research Institute (J.P.McE., J.A.L.); GlaxoSmithKline (T.S.S., J.A.L.); Janssen Pharmaceutica (D.D.M., R.A.R., J.P.McE., B.L.S., M.H.C., R.S.E.K., T.S.S., J.A.L.); Novartis (B.L.S., J.A.L.); Organon (D.D.M., M.H.C.); Ortho-McNeil Neurologics (S.N.C.); Pfizer Inc (D.D.M., S.N.C., J.P.McE., M.H.C., M.S.S., R.S.E.K., J.A.L.); Solvay (M.H.C., J.A.L.). S.M.D is an employee of Quintiles.

Background

There are claims that second-generation antipsychotics produce fewer extrapyramidal side-effects (EPS) compared with first-generation drugs.

Aims

To compare the incidence of treatment-emergent EPS between second-generation antipsychotics and perphenazine in people with schizophrenia.

Method

Incidence analyses integrated data from standardised rating scales and documented use of concomitant medication or treatment discontinuation for EPS events. Mixed model analyses of change in rating scales from baseline were also conducted.

Results

There were no significant differences in incidence or change in rating scales for parkinsonism, dystonia, akathisia or tardive dyskinesia when comparing second-generation antipsychotics with perphenazine or comparing between second-generation antipsychotics. Secondary analyses revealed greater rates of concomitant antiparkinsonism medication among individuals on risperidone and lower rates among individuals on quetiapine, and lower rates of discontinuation because of parkinsonism among people on quetiapine and ziprasidone. There was a trend for a greater likelihood of concomitant medication for akathisia among individuals on risperidone and perphenazine.

Conclusions

The incidence of treatment-emergent EPS and change in EPS ratings indicated that there are no significant differences between second-generation antipsychotics and perphenazine or between second-generation antipsychotics in people with schizophrenia.


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R. A. Rosenheck and M. J. Sernyak
Developing A Policy For Second-Generation Antipsychotic Drugs
Health Aff., September 1, 2009; 28(5): w782 - w793.
[Abstract] [Full Text] [PDF]