title: Long-term (3-year) effectiveness of haloperidol, risperidone and olanzapine: results of a randomized, flexible-dose, open-label comparison in first-episode nonaffective psychosis.
abstract: BACKGROUND
  To enhance the effectiveness of antipsychotics in first-episode psychosis is crucial in order to achieve the most favourable prognosis. Difference in effectiveness between antipsychotics is still under debate.
  
  
  OBJECTIVE
  The purpose of this study is to determine the long-term (3-year) effectiveness and efficacy of haloperidol, risperidone and olanzapine in first-episode schizophrenia-spectrum disorders.
  
  
  METHODS
  This is a prospective, randomized, open-label study. Data for the present investigation were obtained from a large epidemiologic and 3-year longitudinal intervention programme of first-episode psychosis. One hundred seventy-four patients were randomly assigned to haloperidol (N = 56), olanzapine (N = 55), or risperidone (N = 63) and followed up for 3 years. The primary effectiveness measure was all-cause of treatment discontinuation. In addition, an analysis based on per-protocol populations was conducted in the analysis for clinical efficacy.
  
  
  RESULTS
  The treatment discontinuation rate for any cause differed significantly between treatment groups (χ (2) = 10.752; p = 0.005), with a higher rate in haloperidol than in risperidone and olanzapine. The difference in the discontinuation rate between risperidone and olanzapine showed a tendency towards significance (χ (2) = 3.022; p = 0.082). There was a significant difference in the mean time to all-cause discontinuation between groups (log-rank χ ( 2 ) = 12.657;df = 2; p = 0.002). There were no significant advantages to any of the three treatments in reducing the psychopathology severity.
  
  
  CONCLUSIONS
  After 3 years of treatment, a lower effectiveness was observed in haloperidol compared to second-generation antipsychotics (SGAs). The use of SGAs for the treatment of early phases of nonaffective psychosis may enhance the effectiveness of antipsychotics.
authors: University Hospital Marqués de Valdecilla, IFIMAV, Department of Psychiatry, School of Medicine, University of Cantabria, Planta 2ª, Edificio 2 de Noviembre. Avda. Valdecilla s/n, 39008 Santander, Spain. bcfacorro@humv.es
authors: Benedicto
authors: B
authors: Crespo-Facorro
authors: Rocío
authors: R
authors: Pérez-Iglesias
authors: Ignacio
authors: I
authors: Mata
authors: Obdulia
authors: O
authors: Martínez-Garcia
authors: Victor
authors: V
authors: Ortiz
authors: Jose Maria
authors: JM
authors: Pelayo-Terán
authors: Elsa
authors: E
authors: Valdizan
authors: José Luis
authors: JL
authors: Vazquez-Barquero
mesh_terms: D000328:Adult; D001569:Benzodiazepines / Q000627:therapeutic use*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006220:Haloperidol / Q000627:therapeutic use*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D000077152:Olanzapine; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology*; D018967:Risperidone / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001569:Benzodiazepines; D006220:Haloperidol; D018967:Risperidone; D000077152:Olanzapine