What is the difference between olanzapine and quetiapine

Outcomes related to symptom reduction and increased functioning are shown in Additional file 2 and Figures 5 and 6. There were significant differences among SGAs as quetiapine was superior to risperidone and olanzapine in reducing the PANSS total score and the positive subscore. Curves for each individual regarding the PANSS total score revealed a steeper decline initially as compared to later in the follow-up period curves not shown.

Curves for each individual on the other outcomes followed the same general pattern, with the slope being steepest initially curves not shown. The sensitivity analyses in separate follow-up periods were performed from baseline to 90 days, corresponding to the steep part of the course, and after 90 days, corresponding to the flatter part of the course.

The analyses revealed trends for the RGs that were essentially similar to the findings for the whole 2-year follow-up data not shown. The differences were no longer statistically significant after adjusting for multiple comparisons. Linear mixed effects model curves.

Linear slopes for the randomization groups generated based on linear mixed effects models PANSS total score output as displayed in Additional file 2 for risperidone, olanzapine, quetiapine, and ziprasidone, respectively. The curves are confined to the first days because the major bulk of data is obtained before days. The curves are generated based on drug-specific linear mixed effects slopes as displayed in Additional file 2 for risperidone, olanzapine, quetiapine, and ziprasidone, respectively.

Sensitivity analyses that excluded patients with drug-induced psychoses revealed essentially identical results with regards to symptom reduction and increased functioning.

There were differences among the drugs for only a limited number of tolerability outcomes Additional file 3. There were generally no substantial differences among FCGs on baseline demographic and clinical characteristics with the exception of a slightly higher PANSS positive subscore for olanzapine The mean doses in milligrams per day with standard deviations SD were 3. The mean serum levels in nanomoles per liter with SD were The reference ranges were , , , and for risperidone, olanzapine, quetiapine, and ziprasidone, respectively.

A total of 24 There were no differences among the FCGs in the rates of change or choice of new antipsychotic drug. One or more doses of low-potency first-generation antipsychotics were given to 15 patients There were no differences among the FCGs in the number of patients receiving additional antipsychotics or the mean daily additional antipsychotic dose in chlorpromazine equivalents. Seventy-one In 30 There were no differences among FCGs in the use of these additional psychotropics.

Anticholinergics were prescribed for 6 The corresponding figures were 1 3. There were no differences among FCGs in the rates of users of antipsychotics the year prior to index hospitalization.

Times until discharge from index admission and until readmission were not different among FCGs. Symptom reduction outcomes were not substantially different from those of the primary analyses Additional file 2.

Sensitivity analyses before 90 days in the FCGs revealed trends similar to the ones from the ITT-analyses for the PANSS total and subscores, with the quetiapine group having the steepest slope, though not statistically significant. Baseline registrations of laboratory measures were not different in FCGs with the exception of a higher baseline prolactin level for risperidone Mean The risperidone group had larger increase of body weight per day than the olanzapine and quetiapine groups; as well as larger increase per day of BMI compared to the olanzapine group.

The study represents a naturalistic approach to the issue of effectiveness among first-choice SGAs and which of these should be preferred for a patient suffering from psychosis.

The sample thus represents a heterogeneous group of patients with psychosis. The SGAs performed equally in the ITT analyses regarding times until discontinuation of the first offered antipsychotic drug, until discharge from index admission, and until readmission. Olanzapine-treated FCGs showed a significantly longer time to discontinuation compared with the ziprasidone-treated FCGs in the secondary analyses. Superior drug survival or better adherence for patients treated with olanzapine was also found in the systematic review on head-to-head effectiveness of SGAs, but only in chronic patients [ 9 , 28 — 30 ].

In one study on chronic patients who had discontinued perphenazine, both olanzapine and quetiapine groups had significantly longer time until treatment discontinuation than risperidone [ 30 ]. In the EUFEST study comparing haloperidol with SGAs in first-episode psychosis differences in all-cause discontinuation risk were lower with amisulpride, olanzapine, quetiapine, and ziprasidone, compared with haloperidol [ 27 ]. Because our sample consisted of both first-episode and chronically ill patients it seems reasonable that our results regarding drug survival was intermediate between those from chronic phase and first-episode studies.

Alternatively the limited N in our study could represent a risk of a statistical type I error because of inadequate power, and we may accordingly have missed further differences among the groups. The outcomes for symptom reduction were unexpected.

The mean CDSS baseline score was rather low, however. The results were similar for both RGs and FCGs, and their validity is further strengthened by the inherent consistency among outcomes on different rating scales, and that similar trends were found in supplemental analyses before and after 90 days. The latter analyses only revealed a few statistically significant differences between drugs, probably because of reduced statistical power in the supplemental analyses.

To the authors' best knowledge, this is the first effectiveness study to show such differences among SGAs. In the systematic review on antipsychotic effectiveness the SGAs performed equally regarding their ability to alleviate symptoms of psychosis in all the acute phase studies including studies on first-episode patients, and in all but one chronic phase study [ 8 , 28 — 40 ]. The latter study found olanzapine to be superior to quetiapine in chronic schizophrenia patients that had previously discontinued an SGA because of intolerability [ 29 ].

In one study quetiapine performed better than risperidone on depression outcomes [ 36 ]. There were significant differences for the CGI and GAF scores, and amisulpride had the most favorable and haloperidol the least favorable outcomes in this regard. Hypothetically, this could influence the results as the response to antipsychotics is usually better for first episode patient compared to chronic multi-episode patients. We have not been able to find any differences in baseline demographic or clinical characteristics that could introduce a systematic bias to the results.

In the secondary analyses based on FCGs the only significant difference among the drugs was a slightly higher PANSS positive score for the olanzapine group at baseline. As the outcome measure is reduction of PANSS positive score per day, the expected bias could actually be in favor of olanzapine as a higher baseline score has a higher potential for decrease.

One could argue that given the naturalistic design with assessments not restricted to the time frame of actual use of the first SGA, the outcomes may not be related to that particular SGA but to subsequent medications. We have, however, demonstrated that about three-quarters of the patients did not change their original SGA, and that there were no differences among groups in the rate of antipsychotic medication changes or the choice of a new antipsychotic agent for those who did change.

Furthermore, time until discontinuation was generally the same for all SGAs with the exception of olanzapine- versus ziprasidone-treated FCGs. Nor were there any differences in prescription rates of concomitant benzodiazepines, antidepressants, additional antipsychotics, or mood stabilizers. The outcomes for tolerability were generally the same across groups. This is consistent with the findings of other effectiveness studies in which the SGAs performed equally on most tolerability outcomes [ 9 , 28 — 40 ].

The most consistent difference between the SGAs across studies in the systematic review where related to weight gain and adverse influence on cholesterol and triglyceride levels [ 8 ]. In the EUFEST study there were only differences between haloperidol, amisulpride, olanzapine, quetiapine, and ziprasidone with regards to akathisia, parkinsonism, weight gain from baseline, and hyperprolactinemia [ 27 ].

The results may suggest that clear-cut side-effect profiles from premarketing RCTs are less distinct in a naturalistic setting where samples are more heterogeneous and concomitant medications less restricted.

Our secondary outcomes on metabolic effects were somewhat surprising as the olanzapine-treated FCG was the only group that had a reduction of triglycerides, and even though patients in all FCGs gained weight and BMI, olanzapine-treated patients did so to a lesser degree than those in the other groups. One explanation may be that there is a high awareness among clinicians of olanzapine-associated metabolic adverse effects and that patients at risk of massive weight gain were identified very early and changed to another antipsychotic agent.

Obviously, interactions with concomitant psychotropic drugs may also confuse the picture. The finding of equality among FCGs regarding neurological side effects must be interpreted bearing in mind that there was a significant difference among FCGs in the use of anti-cholinergic drugs, with the risperidone-treated patients having the highest rate of anti-cholinergic prescriptions. The finding of equality among FCGs regarding prolactin elevation should also be interpreted in light of the significantly higher baseline prolactin level in risperidone-treated patients compared with patients in both quetiapine-and ziprasidone-treated groups.

The outcomes for autonomic side effects should be interpreted with caution because of their borderline internal reliability. Some limitations to the study need to be discussed. The randomization was open to both the treating clinician and the patient. Systematic utilization differences among the SGAs before the start of the study could theoretically have introduced bias if some of the SGAs under investigation were associated with more prior experience among the RGs.

The direction of such theoretical bias is hard to predict, as both negative and positive prior experiences could influence the attitude towards the SGAs under investigation. Both treatments were well tolerated, especially no EPS occurred during 8 weeks of treatment. Both quetiapine and olanzapine improved cognition; however, the improvement in cognitive index scores was more marked in patients receiving quetiapine.

Abstract Neurocognitive impairment is a core feature in the pathology of schizophrenia and considered to be relatively persistent towards psychopharmacological interventions. Hum Psychopharmacol. The American Journal of Psychiatry. BMC Psychiatry. About the Calgary Depression Scale for Schizophrenia. J Clin Exp Neuropsychol. New Dir Ment Health Serv. Google Scholar. Davis JM: Dose equivalence of the antipsychotic drugs. J Psychiatr Res. Cochrane Handbook for Systematic Reviews of Interventions 5.

The R Project for Statistical Computing. Book Google Scholar. J Subst Abuse Treat. Escamilla MA: Diagnosis and treatment of mood disorders that co-occur with schizophrenia. Psychiatr Serv. Br J Psychiatry Suppl. J Clin Psychopharmacol.

N Engl J Med. Johnsen E, Jorgensen HA: Effectiveness of second generation antipsychotics: a systematic review of randomized trials.

Download references. We also wish to thank the Division of Psychiatry, Haukeland University Hospital for financial support, and the Clinical Departments for enthusiasm and cooperation. University of Bergen, Inst. Biological and Medical Psychology, Norway. You can also search for this author in PubMed Google Scholar. Correspondence to Eirik Kjelby.

The supporters had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review or approval of the manuscript. Johnsen E has received honoraria for lectures given in meetings arranged by Bristol-Myers Squibb, Eli Lilly, and AstraZeneca, and for a contribution to an information brochure by Eli Lilly. EK drafted the manuscript and participated in the statistical analyses. EJ helped to draft the manuscript, provided statistical analyses and performed the main part of the data collection.

All authors read and approved the final manuscript. Additional file 1: Demographic and clinical characteristics at baseline. DOC 82 KB. This article is published under license to BioMed Central Ltd. Reprints and Permissions. Kjelby, E. Anti-depressive effectiveness of olanzapine, quetiapine, risperidone and ziprasidone: a pragmatic, randomized trial. BMC Psychiatry 11, Download citation.

Received : 18 February Accepted : 31 August Published : 31 August Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Abstract Background Efficacy studies indicate anti-depressive effects of at least some second generation antipsychotics SGAs.

Methods Adult patients acutely admitted to an emergency ward for psychosis were randomized to olanzapine, quetiapine, risperidone or ziprasidone and followed for up to 2 years. Results A total of patients were included. Conclusions There was no substantial difference in anti-depressive effectiveness among olanzapine, quetiapine, risperidone or ziprasidone in this clinically relevant sample of patients acutely admitted to hospital for symptoms of psychosis.

Trial Registration ClinicalTrials. Methods Study design Methods have been described in more detail in a previous publication [ 24 ]. Patients The Regional Committee for Medical Research Ethics allowed eligible patients to be included before informed consent was provided, thus entailing a clinically relevant representation in the study.

Treatments The pragmatic design aspired to mimic the normal clinical situation with regards to treatment allocation without compromising the randomization which protects against systematic differences between groups that are not related to the treatment.

Assessments Assessments were performed at the following points of time: at baseline, at 6 weeks from baseline or at discharge if discharged before 6 weeks from baseline and at 3, 6, 12 and 24 months from baseline. Statistical procedures The primary analyses were intention-to-treat ITT analyses based on the randomization groups RGs. Results The patient enrolment is displayed in Figure 1. Figure 1. Full size image.

Figure 2. Figure 3. Figure 4. Discussion The primary aim of the present study was to investigate whether differential anti-depressive effectiveness is present among olanzapine, quetiapine, risperidone and ziprasidone in a clinically relevant sample of patients acutely admitted to hospital for symptoms of psychosis. Conclusions In conclusion, the results of this study demonstrate no substantial differences in anti-depressive effectiveness between olanzapine, quetiapine, risperidone and ziprasidone in a clinically relevant sample of psychotic patients with moderate depressive symptoms.

References 1. Article PubMed Google Scholar 9. Article PubMed Google Scholar Quetiapine appears to have a similar weight gain profile to risperidone, as well as clozapine and aripiprazole although data are very limited for the latter two comparators.

Quetiapine may produce greater weight gain than ziprasidone and less weight gain than olanzapine and paliperidone. Most data that have been reported within existing comparisons are of very limited value because of assumptions and biases within them.

Much scope is available for further research into the effects of this widely used drug. In many countries, second-generation 'atypical' antipsychotic drugs have become the first-line drug treatment for people with schizophrenia. It is not clear how the effects of the various second-generation antipsychotic drugs differ.

To evaluate the effects of quetiapine compared with other second-generation atypical antipsychotic drugs in the treatment of people with schizophrenia and schizophrenia-like psychoses.

We searched the Cochrane Schizophrenia Group Trials Register May , inspected references of all identified studies, and contacted relevant pharmaceutical companies, drug approval agencies and authors of trials for additional information.

We included all randomised controlled trials RCTs comparing oral quetiapine with other oral forms of atypical antipsychotic medication in people with schizophrenia or schizophrenia-like psychoses.