Bitter pill: costs surge for new schizophrenia drugs.

Medications widely prescribed to treat schizophrenia cost hundreds of dollars more each month than does a less popular, older medication that has similar success at alleviating symptoms of the disorder.

That's one conclusion of the latest analyses from a federally funded study. It tracked people with longstanding schizophrenia who were given 18 months of treatment with a traditional antipsychotic medication or one of four new drugs, known as atypical antipsychotics.

"The bottom line is that the old drug is substantially less expensive and no less effective than the new drugs are," says psychiatrist Robert A. Rosenheck of Yale University School of Medicine. His team presents its findings in the December American Journal of Psychiatry.

Another analysis of the same study recommends a cautious approach to changing a patient's medications.

Researchers followed 1,493 people, ages 18 to 65, who had been diagnosed with schizophrenia. Hallmarks of this mental ailment include hallucinations, delusions, confused thinking, and severe apathy. During the study, the participants received an antipsychotic medication and psychosocial treatment at any of 57 U.S. clinical sites.

Initial results indicated that patients' symptoms improved about as much with the old drug, perphenazine, as with three of the new drugs--quetiapine, risperidone, and ziprasidone (SN: 9/24/05, p. 195). A fourth new drug, olanzapine, proved slightly better at reducing symptoms, but patients receiving it experienced more diabetes-related problems than the other patients did.

Rosenheck's team found that the newer drugs cost $300 to $600 more per month than the old drug.

Although older antipsychotics may offer a cheaper, equally effective alternative to newer ones, critical questions remain, comments a group led by psychiatrist Robert Freedman, editor of the American Journal of Psychiatry, in an accompanying editorial. Short-term data suggest that some of the new drugs increase rates of diabetes and heart disease and some older drugs promote movement and neurological disorders. Only a longer study could establish such differences, the group says.

Psychologist Susan M. Essock of the Mt. Sinai School of Medicine in New York City and her team report in the same journal results of a second new analysis. They find that volunteers randomly assigned to stay on the antipsychotic medication that had originally stabilized their mental states improved more and developed fewer side effects than did participants who switched medications.

Physicians and patients should be wary of the common practice of switching medications in the hope of finding the one that yields the strongest symptom relief and the fewest side effects, Essock says.

When patients entered the study, they had been receiving one or more antipsychotic drugs for an average of 14 years, so Essock's study doesn't give guidance about whether to try out different medications early in the treatment, says psychiatrist Carol A. Tamminga of the University of Texas Southwestern Medical Center in Dallas. That decision is difficult because each schizophrenia medication has different effects, she notes.

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