Efficacy and tolerability of switching to ziprasidone from olanzapine, risperidone or haloperidol: an international, multicenter study

Jun 18, 2009International clinical psychopharmacology

How well patients tolerate and respond to switching to ziprasidone from olanzapine, risperidone, or haloperidol: an international study

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Abstract

A switch to ziprasidone resulted in significant improvement in psychiatric symptoms after 12 weeks of treatment.

Stable outpatients with schizophrenia or schizoaffective disorder were switched from haloperidol, olanzapine, or risperidone due to suboptimal efficacy or side effects.
Completer rates at the end of the study were 68% for haloperidol, 60% for risperidone, and 86% for olanzapine.
Statistically significant improvements were observed in psychiatric symptom scores and overall functioning after switching to ziprasidone.
The switch led to a reduction in extrapyramidal symptoms and had a neutral impact on metabolic parameters.
Weight changes varied, with switching from olanzapine and risperidone resulting in weight reduction, while some weight increase was noted after switching from haloperidol.

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To compare the effectiveness of a switch from haloperidol (N=99), olanzapine (N=82), or risperidone (N=104) to 12 weeks of treatment with 80-160 mg/day ziprasidone in patients with stable schizophrenia or schizoaffective disorder. Stable outpatients with persistent symptoms or troublesome side effects were switched using one of three 1-week taper/switch strategies as determined by the investigator. Efficacy was assessed using the Brief Psychiatric Rating Scale score, Clinical Global Impression, Positive and Negative Symptom Scale, Montgomery-Asberg Depression Rating Scale, and the Global Assessment of Functioning Scale, and tolerability by using standard measures of weight change, extrapyramidal symptoms, and laboratory findings. Suboptimal efficacy was the primary reason for switching. The preferred switch strategy was immediate discontinuation, and the preferred dosing regimen was 120 mg/day. Completer rates were 68, 60, and 86% in the haloperidol, risperidone, and olanzapine pre-switch groups, respectively. At week 12, a switch to ziprasidone resulted in statistically significant improvement from baseline on the Brief Psychiatric Rating Scale score, Clinical Global Impression-Improvement, Positive and Negative Symptom Scale, and Global Assessment of Functioning scales, reduction in extrapyramidal symptoms and a neutral impact on metabolic parameters. Switch from olanzapine and risperidone resulted in weight reduction and from haloperidol in some weight increase. In conclusion, oral ziprasidone of 80-160 mg/day with food was a clinically valuable treatment option for stable patients with schizophrenia or schizoaffective disorder experiencing suboptimal efficacy or poor tolerability with haloperidol, olanzapine, or risperidone.

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Efficacy and tolerability of switching to ziprasidone from olanzapine, risperidone or haloperidol: an international, multicenter study

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