Atypical antipsychotic agents; Peas in a pod or chalk and cheese?

Ajeet B Singh,Lakshmi N Yatham,Michael Berk,Andrew A Nierenberg

doi:10.1186/s12916-014-0126-1

Abstract

With escalating health expenditure and a shrinking purse, there is increased focus on the cost efficacy of still patented versus generic medications in general, and for atypical antipsychotics in particular. In a recent BMC Medicine article, Godman and colleagues presented data indicating poor uptake of the off patent atypical antipsychotic risperidone, arguing for authorities to mandate its greater use. This is under the assumption of clinical equivalence of atypical antipsychotics. This commentary argues that there are clinically meaningful differences between atypical antipsychotics and important inter-individual heterogeneity in clinical response and tolerability. Access to a broad range of atypical antipsychotics enables clinicians to tailor care, taking consideration of differential efficacy and adverse effects profile in order to meet the needs of individual patients with improved real world effectiveness of treatment. Restriction of agent choice risks detracting from optimal clinical care, with possible poorer outcomes and greater costs of care. A balance between encouraging use of cheapest in class agent and allowing access to various atypical agents for tailored care is likely to produce optimal health outcomes.Please see related article: http://www.biomedcentral.com/1741-7015/12/98.

Highlights

In an economic climate characterised by rising public debt, sluggish economic growth and rapidly expanding health care expenditures, there is increasing pressure on restraining the pace of growth of the health care budget
Their data indicate that once generic risperidone was available, it was prescribed less, and there was a wide variance between countries in the proportion of risperidone scripts that were generic versus brand name
Atypical antipsychotics are widely used as adjuncts to antidepressants to treat refractory unipolar major depression, and here again, while quetiapine, aripiprazole, risperidone and olanzapine have efficacy based on meta-analytical data, the number needed to treat for response and remission are much higher and the number needed to harm are much lower for olanzapine compared with other atypical antipsychotics [7]

Summary

Introduction

In an economic climate characterised by rising public debt, sluggish economic growth and rapidly expanding health care expenditures, there is increasing pressure on restraining the pace of growth of the health care budget. * Correspondence: a.singh@deakin.edu.au 1IMPACT Strategic Research Centre, School of Medicine, Deakin University, PO Box 281, Geelong 3220, Australia Full list of author information is available at the end of the article prescribed atypical antipsychotics there was no increased prescribing of generic risperidone when it may have been a valid treatment option. The authors argue that their data have significant implications for health care costs and suggest that health authorities encourage prescribing of cheaper generics versus allowing prescribers to tailor treatment to patient needs based on differential medication side effect and efficacy profiles.

Results

Conclusion