RISPERIDONE VERSUS HALOPERIDOL IN THE TREATMENT OF SCHIZOPHRENIA - A METAANALYSIS COMPARING THEIR EFFICACY AND SAFETY

The aim of this study was to compare the shortterm clinical efficacy a nd safety of risperidone with haloperidol and placebo. A meta-analysis of seven published randomized double-blind controlled trials was carr ied out. Study quality was assessed. The proportion of patients failin g to reach at least 20% improvement on the positive and negative syndr ome scale (PANSS) or brief psychiatric rating scale (BPRS), the propor tion of patients discontinuing treatment because of adverse effects an d the number of patients who needed antiparkinsonian medication were a bstracted for use as outcome measures. Treatment failure was present i n 50% of risperidone-treated patients compared to 66% in those treated with haloperidol and 83% in those treated with placebo. It would be n ecessary to treat II patients with risperidone to prevent one treatmen t failure in those patients treated with haloperidol (Odds ratio (OR) = 0.74, 95% CI of 0.58 - 0.94, P = 0.02). Pooling of the three multice ntre trials which included placebo as a treatment arm, showed that one in three patients treated with risperidone 4 - 16 mg/day (OR = 0.22, 95% CI of 0.13 - 0.39, P < 0.00001) and one in six treated with halope ridol 10 - 20 mg/day (OR = 0.44, 95% CI of 0.22 - 0.84, P = 0.02) woul d derive significant benefit. Moreover, there was a highly significant greater need for anticholinergic medication due to extrapyramidal sym ptoms (EPS) in the haloperidol-treated patients compared to risperidon e (OR = 0.54, 95% CI of 0.42 - 0.70, P < 0.00001). In conclusion, risp eridone seems to be more effective and causes less EPS than haloperido l, as suggested by the significantly lower requirement for antiparkins onian medication.