Zyprexa scientific update |
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University of Pennsylvania School of Medicine 2006,Nov 22
By Jeff Minerd, Reviewed by Zalman S. Agus
Zyprexa is effective drug but may have metabolic effect
It is reported that Zyprexa is an effective drug for the treatment of Schizophrenia. This antipsychotic medication is the most effective drug for schizophrenia. Continuous use of Zyprexa may some times cause metabolic issues.
The newer atypical antipsychotic drugs may not always outperform the old ones in managing schizophrenia, investigators said here. That's what the results of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study suggested, said Rajiv Tandon, M.D., of the University of Florida in Tallahassee.
Dr. Tandon discussed the CATIE trial and its results at a symposium held in conjunction with the U.S. Psychiatric & Mental Health Congress here. The symposium was sponsored by Janssen pharmaceuticals of Titusville, N.J. In CATIE, nearly 1,500 patients with schizophrenia (ages 18 to 65) were recruited at 57 sites in the U.S. Participants were randomly assigned to Zyprexa (olanzapine) at 7.5 to 30 mg per day, Triavil (perphenazine) at 8 to 32 mg per day, Seroquel (quetiapine) at 200 to 800 mg per day, Risperdal (risperidone) at 1.5 to 6 mg per day, or Geodon (ziprasidone) at 40 to 160 mg per day.
Triavil is an older, typical antipsychotic developed in the mid-1950s. This class of drugs is associated with extrapyramidal side effects, Dr. Tandon noted. Follow-up in CATIE was 18 months. Endpoints included time to discontinuation of a particular drug as well as efficacy measures. Discontinuation of antipsychotic medications is common because they don't work in all patients and because of adverse effects, including metabolic side effects, extrapyramidal side effects, and weight gain, Dr. Tandon said. Overall, 74% of patients discontinued their study medication and switched to a new medication before 18 months, including:
• 49% of those assigned to Zyprexa.
• 55% of those assigned to Risperdal.
• 65% of those assigned to Seroquel.
• 70% of those assigned to Geodon and Triavil.
The time to discontinuation of treatment for any cause was significantly longer in the Zyprexa group than in the Seroquel (P<0.001) or Risperdal (P=0.002) group, but not in the Triavil (P=0.021) or Geodon (P=0.028) group. The times to discontinuation because of intolerable side effects were similar among the groups. However, Zyprexa was associated with more discontinuation for weight gain or metabolic effects, and Triavil was associated with more discontinuation for extrapyramidal effects. Zyprexa was the most effective drug in terms of the rates of discontinuation, but it was the "worst offender" in terms of metabolic side effects, Dr. Tandon said.
Furthermore, the efficacy of the typical antipsychotic Triavil appeared similar to that of Seroquel, Risperdal, and Geodon in patients at low risk for extrapyramidal side effects, he said. The CATIE study suggests that in schizophrenic patients with a low risk for extrapyramidal side effects, typical antipsychotics may work as well as the atypical "if you can get the dosing just right," Dr. Tandon said. Individual dosing is the key because there is considerable variation in how patients respond to differing doses of antipsychotic drugs and in patients' susceptibility to their side effects, Dr. Tandon said.
Successfully managing schizophrenia is crucial because the disease is such a heavy burden not only on individuals but on the healthcare system, said Jacqueline M. Feldman, M.D., of the University of Alabama at Birmingham, a second speaker at the symposium. Half of all mental hospital beds are filled by patients with schizophrenia, Dr. Feldman said. And about 16% of all patients getting healthcare services have schizophrenia, she added. Half of schizophrenia patients attempt suicide at some point during their lives, and 10% of them succeed. Finally, one-third to two-thirds of the homeless in the United States have schizophrenia, Dr. Feldman said.
New York State Psychiatric Institute, Columbia University Medical Center 2005,July 15
Jeffrey Lieberman, M.D.
published in NY
Zyprexa in schizophrenia proved to prevent brain loss
A recent study proved that Zyprexa has the capability to prevent brain loss. Zyprexa is more effective than any other conventional antipsychotic drug. It can prevent the loss of gray matter which contains brains cell's and billions of connections among the cells.
A new brain imaging study of recently diagnosed schizophrenia patients has found, for the first time, that the loss of gray matter typically experienced by patients can be prevented by one of the new atypical antipsychotic drugs, Zyprexa (olanzapine), but not by haloperidol, an older, conventional drug. The study also confirmed previous studies that show patients who experience less brain loss do better clinically.
"This is a really big breakthrough," says the study's leader, Jeffrey Lieberman, M.D., director of the New York State Psychiatric Institute and chairman of psychiatry at Columbia University Medical Center. "The drugs we have for schizophrenia can't cure people who've been sick for years, but this study shows that the newer atypical drugs, if started early, can prevent the illness from progressing. If our findings are confirmed, one could argue that we should treat new patients with atypical drugs like Zyprexa (olanzapine) rather than older conventional medications such as haloperidol and chlorpromazine." Gray matter contains the bulk of the brains cell's and the billions of connections among the cells. Loss of gray matter in patients with schizophrenia has been linked to social withdrawal and progressive deterioration in cognition and emotion-which are among the least responsive symptoms to medications.
To see if antipsychotic drugs could slow the initial brain changes in new patients, Dr. Lieberman and colleagues at 14 sites in North America and Europe measured brain volume and cognitive changes in 263 first-episode schizophrenia patients and 58 non-schizophrenic volunteers over a two-year period. Half of the patients received the atypical antipsychotic Zyprexa (olanzapine) and the other half took the conventional antipsychotic haloperidol. Dr. Lieberman initiated the study when he was professor of psychiatry at the University of North Carolina, which also coordinated the research.
The study found that, on average, haloperidol-treated patients lost about two percent of their gray matter, or about 12 cubic centimeters. No changes were detected in the olanzapine-treated patients and the normal volunteers. Patients who lost gray matter, particularly in the frontal lobe of the brain, also had greater problems with cognitive functioning, as measured by tests of verbal fluency, verbal learning and memory.
Schizophrenia has always been known as a disease that causes progressive worsening of symptoms and deterioration in function, but only in the last 10 years have researchers found that the brains of schizophrenics are also progressively deteriorating.
"People used to think that the deterioration was inevitable, but now we're thinking that if you can prevent the acute episodes of psychosis in schizophrenia you can actually stop the loss of gray matter," Dr. Lieberman says.
"It also gives us hope that we will be able to completely forestall the disease in the future by intervening before psychosis even begins," Dr. Lieberman adds. "In three to five years, we should have ways to identify which adolescents will become schizophrenic, and we can then begin to test the preventative power of treatments."
Am J Health Syst Pharm. 2005 Mar 15;62(6):610-5.
Russo PA, Smith MW, Namjoshi M.
Outcomes Research and Econometrics, The Medstat Group, Washington, DC.
Health care costs for schizophrenia patients started on olanzapine versus risperidone.
Author summarizes the difference in cost of treatment for schizophrenia using olanzapine or risperidone. From the study conducted, it is clear that Olanzapine initiators are more expensive than risperidone initiators. But in total, there is no significant difference in the treatment using Olanzapine initiators or risperidone initiators.
PURPOSE: The change in direct medical costs for schizophrenia patients who were started on olanzapine or risperidone and who were privately insured was studied. METHODS: A retrospective analysis of 1996-1999 data from the databases representing the health care experiences of individuals employed by large organizations and their dependents was performed. The sample included all individuals with a drug claim for olanzapine or risperidone, a claim with a schizophrenia diagnosis within 90 days of the drug claim, no claim for the same drug in the prior six months, and continuous health-plan enrollment for 12 months before and after the prescription. RESULTS: The sample included 162 patients initiated on olanzapine and 119 patients initiated on risperidone. Demographic and clinical profiles were not significantly different between groups. Annual schizophrenia-related prescription and outpatient costs increased following initiation on olanzapine or risperidone compared with the preinitiation period. This was partially offset by a decrease in inpatient expenditures. Olanzapine initiators had higher outpatient drug expenditures than risperidone initiators in the 12 months following initiation (adjusted means, $2105 versus $1934) (p < 0.05), but there was no significant difference between groups in total schizophrenia-related payments ($5251 versus $4950). CONCLUSION: The total health care expenditure related to treating schizophrenia was similar between privately insured patients who were initiated on olanzapine and patients who were started on risperidone.
Arch Phys Med Rehabil. 2005 Mar;86(3):587-90.
Mukand JA, Fitzsimmons C, Wennemer HK, Carrillo A, Cai C, Bailey KM.
Olanzapine for the treatment of hemiballismus: A case report.
A research report on the treatment of hemiballismus using Olanzapine. Zyprexa is effective in the treatment of hemiballismus than haloperidol. This drug has the power to reduce the effect of agitation in hemiballismus patients.
Olanzapine for the treatment of hemiballismus: a case report.
Hemiballismus is a rare movement disorder characterized by involuntary, large amplitude movements of the limbs of 1 side of the body. We describe the case of a man in his late sixties with slurred speech, agitation, and right-sided hemiballismus resulting from a left thalamic hemorrhagic stroke. Treatment with haloperidol was unsuccessful, but both the hemiballismus and agitation diminished significantly after initiation of olanzapine (Zyprexa). The improvement in the hemiballismus was quantified by recording the number of hemiballistic movements that occurred while the patient performed standardized 30-minute sessions (daily for 5d). With the first task (reaching within the base of support while seated), the average number of hemiballismic movements per session decreased from a baseline of 23.5 to 3.0 in the upper extremity and from 20.5 to 7.0 in the lower extremity. With the second task (catching a ball while seated), the abnormal movements decreased from 52 to 6.3 in the upper extremity and from 34.5 to 2.7 in the lower extremity. This case suggests that olanzapine may be a valuable pharmacologic alternative for patients with hemiballismus.
Zyprexa description...
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Drug category:Schizophrenia, Psychosis
 Zyprexa scientific update
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