100. Comparative efficacy of olanzapine and haloperidol for patients with treatment-resistant schizophrenia

Abstract

There is relatively little information regarding the efficacy of newer atypical antipsychotic drugs for patients with schizophrenia who are treatment-resistant to neuroleptic agents. Several lines of evidence suggest that a clinical trial of olanzapine in this population is warranted. A sub-population of patients (N = 526) meeting treatment-resistant criteria selected from a large, prospective, double-blind, six-week study assessing the efficacy and safety of olanzapine and haloperidol was examined. Both last-observation-carried-forward (LOCF) and completers (observed cases) analyses were conducted. Olanzapine demonstrated significantly greater mean improvement from baseline in Positive and Negative Syndrome Scale (PANSS) negative symptoms, co-morbid depressive symptoms assessed by the Montgomery-Asberg Depression Rating Scale, akathisia as measured by Barnes Akathisia Scale and extrapyramidal symptoms as measured by Simpson-Angus Extrapyramidal Rating Scale with both LOCF and completers analyses. In addition, olanzapine was significantly superior to haloperidol for Brief Psychiatric Rating Scale (BPRS) total (p = .006), PANSS total (p = .005), and PANSS positive symptoms (p = .017) in completers of the six-week study. Significantly greater response rates were observed in olanzapine-treated (47%) than haloperidol-treated (35%) patients in the LOCF analysis (p = .008), but significance was not reached in the completers analysis (p = .093). Mean doses (±SD) of olanzapine and haloperidol were 11.1 ± 3.4 mg/day and 10.0 ± 3.6 mg/day, respectively. Olanzapine was superior to haloperidol for key symptom domains and parkinsonian adverse events. Implications of these data for the therapeutics of this severely ill subgroup are discussed.