CATIE Study: Antipsychotics in Alzheimer's No Better Than Placebo
Oct 13, 2006 - 11:07:37 AM
Most Alzheimers patients prescribed antipsychotic drugs for delusions, agitation or aggression do no better than those who take a placebo because so many discontinue the drugs due to significant side effects, according to a new nationwide study led by Lon Schneider, professor of psychiatry, neurology and gerontology at the Keck School of Medicine of USC.
The study is highly anticipated because it provides the first long-term comparative look at the three major antipsychotic drugs now used off label to treat difficult symptoms of Alzheimers disease.
We thought overall the drugs would show their effectiveness, Schneider said. The answer is yes, they are somewhat effective, but overall the efficacy is offset by adverse events that resulted in discontinuing the medication. It was a surprise, in that the expert opinion which drove this study was that these drugs are particularly useful in treating these difficult symptoms.
Almost all Alzheimers patients suffer delusions or aggression, Schneider said, which makes their care particularly difficult. The studys 421 participants at 42 nationwide sites all had Alzheimers disease and were experiencing delusions, hallucinations, aggression or agitation that disrupted their daily functioning.
The findings here look at the time to discontinuation for the antipsychotics versus the placebo, and that time difference reflects the overall effectiveness of the medication, Schneider explained. By that measure, the medications were not better than placebo. Patients on the medications were more likely to discontinue because of the side effects, offsetting the efficacy.
Side effects from the three antipsychotic medications olanzapine, quetiapine and risperidone ranged from sedation, weight gain and confusion to worsening psychosis.
Almost a quarter of those taking olanzapine quit because of adverse events, as did 18 percent on risperidone and 16 percent on quetiapine. Those on all three medications were significantly more likely to discontinue treatment than those who received a placebo.
Ultimately between 77 to 85 percent of study participants discontinued their medication, either because of adverse side effects or no improvement.
The results suggest antipsychotic drugs should be prescribed only with some deliberation, Schneider said.
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