Chlorpromazine Versus Atypical Antipsychotic Drugs for Schizophrenia

Summary

A Cochrane review [Abstract] 1 included 71 studies comparing chlorpromazine to olanzapine, risperidone or quetiapine. Thirty-seven of the 45 studies were under 8 weeks in length.

1. Chlorpromazine vs. olanzapine:In the short term, there appeared to be a significantly greater clinical response in people receiving olanzapine (RR 2.34, 95% CI 1.37 to 3.99; 3 RCTs, n = 204). There was no difference between drugs for relapse (RR 1.5, 95% CI 0.46 to 4.86; 1 RCT, n = 70), nor in average endpoint score using the Brief Psychiatric Rating Scale (BPRS) for mental state (MD 3.21, 95% CI −0.62 to 7.05; 4 RCTs, n = 245). There were significantly more extrapyramidal symptoms amongst people receiving chlorpromazine (RR 34.47, 95% CI 4.79 to 248.30; 2 RCTs, n = 298). Quality of life ratings using the general quality of life interview (GQOLI) - physical health subscale were more favourable with people receiving olanzapine (MD −10.10, 95% CI −13.93 to −6.27; 1 RCT, n = 61). There was no difference between groups for people leaving the studies early (RR 1.69, 95% CI 0.45 to 6.40; 3 RCTs, n = 139).
2. Chlorpromazine vs. risperidone:In the short term, there appeared to be no difference in clinical response between chlorpromazine or risperidone (RR 0.84, 95% CI 0.53 to 1.34; 7 RCTs, n = 475), nor in average endpoint score using the BPRS for mental state (MD 0.90, 95% CI −3.49 to 5.28; 4 RCTs, n = 247), or any observed extrapyramidal adverse effects (RR 1.7, 95% CI 0.85 to 3.40; 3 RCTs, n= 235). Quality of life ratings using the QOL scale were significantly more favourable with people receiving risperidone (MD −14.2, 95% CI −20.50 to −7.90; 1 RCT, n = 100). There was no difference between groups for people leaving the studies early (RR 0.21, 95% CI 0.01 to 4.11; 1 RCT, n = 41).
3. Chlorpromazine vs. quetiapine:In the short term, there appeared to be no difference in clinical response between chlorpromazine or quetiapine (RR 0.93, 95% CI 0.81 to 1.06; 28 RCTs, n = 3241) nor in average endpoint score using the BPRS for mental state (MD −0.18, 95% CI −1.23 to 0.88; 6 RCTs, n = 548). Quality of life ratings using the GQOL1-74 scale were significantly more favourable with people receiving quetiapine (MD −6.49, 95% CI −11.30 to −1.68; 1 RCT, n = 59). Significantly more people receiving chlorpromazine experienced extrapyramidal adverse effects (RR 8.03, 95% CI 4.78 to 13.51; 8 RCTs, n = 644). There was no difference between groups for people leaving the studies early in the short term (RR 1.04, 95% CI 0.77 to 1.41;12 RCTs, n = 1223).