Antipsychotics for treatment resistant schizophrenia

News
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Clozapine is often the last resort for treatment-resistant schizophrenia. This is supported by clinical trials, a meta-analysis, a Cochrane review and network meta-analysis (NMA) (Kane et al 1988a, Kane et al 1988b, Wahlbeck et al 1999, Essali et al 2009, Leucht et al 2013).

However, superiority was driven by data from older studies (Kane et al 1988a, Kane et al 1988b). Newer studies show a smaller effect size between clozapine and first generation antipsychotics (Buchanan et al 1998, Rosenheck et al 1997).

Furthermore, a Cochrane Review comparing clozapine to second generation antipsychotics found them to be of similar efficacy and newer second generation antipsychotics could be more effective than clozapine if non-refractory patients are considered (Leucht et al 2013, Asenjo Lobos et al 2010, Leucht et al 2009, Davis et al 2003).

This new paper reviews antipsychotics in treatment resistant schizophrenia using simple pairwise meta-analyses and a network meta-analysis (Samara et al, 2016).

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I managed to stay on Olanzapine, although Clozapine was offered to me, because I still hear voices although feel they are blunted by AP’s.

My thoughts are Clozapine trials will always be biased, whilst you have to have regular blood tests, as you have to come in and see a nurse. My opinion that this will always bias Clozapine trials!

I’m still waiting for targeted treatments, hopefully they will come I my lifetime!

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Schizophrenia with prominent negative symptoms is also a form of treatment resistance. No antipsychotic is effective for negative symptoms, including clozapine.
Targeted treatments will come in the next decade probably, as a result of advancing genetic studies. Until then we have to grit our teeth and endure…