A Randomized Comparison of Aripiprazole and Risperidone for the Acute Treatment of First-Episode Schizophrenia and Related Disorders: 3-Month Outcomes.
Research findings are particularly important for medication choice for first-episode patients as individual prior medication response to guide treatment decisions is unavailable. We describe the first large-scale double-masked randomized comparison with first-episode patients of aripiprazole and risperidone, 2 commonly used first-episode treatment agents. One hundred ninety-eight participants aged 15-40 years with schizophrenia, schizophreniform disorder, schizoaffective disorder or psychotic disorder Not Otherwise Specified, and who had been treated in their lifetime with antipsychotics for 2 weeks or less were randomly assigned to double-masked aripiprazole (5-30 mg/d) or risperidone (1-6 mg/d) and followed for 12 weeks. Positive symptom response rates did not differ (62.8% vs 56.8%) nor did time to response. Aripiprazole-treated participants had better negative symptom outcomes but experienced more akathisia. Body mass index change did not differ between treatments but advantages were found for aripiprazole treatment for total and low-density lipoprotein cholesterol, fasting glucose, and prolactin levels. Post hoc analyses suggested advantages for aripiprazole on depressed mood. Overall, if the potential for akathisia is a concern, low-dose risperidone as used in this trial maybe a preferred choice over aripiprazole. Otherwise, aripiprazole would be the preferred choice over risperidone in most situations based upon metabolic outcome advantages and some symptom advantages within the context of similar positive symptom response between medications.
drobinso@nshs.edu.
Delbert G
DG
Robinson
Juan A
JA
Gallego
Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY; Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY; Department of Mathematics, Hofstra University, Hempstead, NY;
Majnu
M
John
Georgios
G
Petrides
Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY; Departments of Psychiatry, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY;
Youssef
Y
Hassoun
Jian-Ping
JP
Zhang
Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY; Departments of Psychiatry, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY;
Leonardo
L
Lopez
Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY; Departments of Psychiatry, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY;
Raphael J
RJ
Braga
James J. Peters VA Medical Center, Bronx, NY;
Serge M
SM
Sevy
Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada;
Jean
J
Addington
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY;
Charles H
CH
Kellner
Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM;
Mauricio
M
Tohen
Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY;
Melissa
M
Naraine
Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY;
Natasha
N
Bennett
Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY;
Jessica
J
Greenberg
Todd
T
Lencz
Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY.
Christoph U
CU
Correll
Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY Drs Kane and Malhotra are joint last authors.
John M
JM
Kane
Drs Kane and Malhotra are joint last authors.
Anil K
AK
Malhotra
D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D000068180:Aripiprazole / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011618:Psychotic Disorders / Q000188:drug therapy*; D018967:Risperidone / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D012559:Schizophrenia / Q000188:drug therapy*; D055815:Young Adult
D014150:Antipsychotic Agents; D000068180:Aripiprazole; D018967:Risperidone
akathisia; clinical trial; metabolic side effects; negative symptoms; treatment response