J Korean Neuropsychiatr Assoc.
2002 Sep;41(5):876-889.
The Study for Switching Methods to Olanzapine in Korean Schizophrenic Patients Treated with Other Antipsychotics(I): Comparison of Therapeutic Effecacy
- Affiliations
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- 1Department of Psychiatry, Eulji University School of Medicine, Seoul, Korea.
- 2Department of Psychiatry, College of Medicine, Yonsei University, Seoul, Korea.
- 3Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea.
- 4Department of Neuropsychiatry, Korea University Medical College, Seoul, Korea.
- 5Department of Neuropsychiatry, Chung-Ang University College of Medicine, Seoul, Korea.
- 6Department of Psychiatry, Wonju Christian Hospital, Wonju Medical College, Yonsei University, Wonju, Korea.
- 7Ke Yo Hospital, Uiwang, Korea.
- 8Department of Neuropsychiatry, College of Medicine, Ewha Womans University, Seoul, Korea.
- 9Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea.
- 10Department of Psychiatry Uijongbu St. Mary's Hospital The Catholic University of Korea College of Medicine, Uijongbu, Korea.
- 11Department of Neuropsychiatry, Our Lady of Mercy Hospital, The Catholic University of Korea, Incheon, Korea.
- 12Department of Neuropsychiatry, Soonchunhyang University Hospital, Seoul, Korea.
- 13Department of Neuropsychiatry, Kang-Dong Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, Korea.
- 14Seoul National University Medical Research Center, Neuroscience Research Institute, Seoul, Korea.
Abstract
OBJECTIVES
This randomized, multicenter, open-label, parallel clinical trial was carried to compare the therapeutic efficacy and the proportion of successful switch between 'direct switching method' and 'start-tapering switching method' when switching an antipsychotic to olanzapine.
METHODS
This study included both inpatients and outpatients who fulfilled the criteria for schizophrenia as defined in the ICD-10 from 13 hospitals, and were in need to be appropriate for switching antipsychotics. Subjects were randomly assigned to one of the two switching methods. For 'direct switching method' group, previous antipsychotics were abruptly discontinued and 10mg of olanzapine was administered, whereas for 'start-tapering switching method' group, initially 10mg of olanzapine was administered and previous antipsychotics was gradually tapered for 2 weeks. Olanzapine was used for 6 weeks and the dose was adjusted within the range of 5-20mg. The therapeutic efficacy was measured with PANSS, BPRS, and CGI-Severity. A successful switching was defined as the completion of the 6 week trial without either worsening of the symptom(i.e. CGI-S score becomes worse twice consecutively) or the exacerbation of extrapyramidal symptoms(i.e. Simpson-Angus Scale scores becomes worse).
RESULTS
103 schizophrenic patients were participated in this study. There were no differences in baseline characteristics such as the demographic variables, the severity of symptoms, the history of previous antipsychotics treatments, the dosage of olanzapine used and the compliance between two groups. The proportion of successful switch was 71.1% for "direct switching method" and 82.2% for "start-tapering switching method", and there was no significant difference between the two switching methods. Also response rates to olanzapine based on total PANSS total scores were not different between the two groups(26.9% vs. 31.1%). At the time of completion of the trial, the scores of PANSS total, PANSS subscales, CGI-S and BPRS have significantly decreased after switching to olanzapine. But the changes of all scales measuring therapeutic efficacy in both endpoint and weekly analyses were not significantly different between the two switching methods.
CONCLUSION
Although this study trial has many limitations and problems as an open clinical trial, the results may suggest that there were no significant differences between the two switching methods in the therapeutic efficacy. It was also found that the additional therapeutic benefits could be obtained by switching their antipsychotics to olanzapine.
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