Fluphenazine Versus First-Generation and Low-Potency Antipsychotic Drugs for Schizophrenia

Summary

A Cochrane review [Abstract] 1 included 7 studies with a total of 1567 subjects. They had schizophrenia or schizophrenia-like psychosis according to clinical criteria. The low-potency comparators were chlorpromazine, chlorprothixene and thioridazine. In a few studies various low-potency antipsychotics (LPAPs) could be administered. Four studies were conducted in hospitals. Three studies had one month follow-up and two studies up to 2 months follow-up, 2 studies had 3 to 6 months follow-up. Fluphenazine was not significantly different from LPAPs in terms of response to treatment (fluphenazine 55%, LPAPs 55%, RR 1.06, CI 0.75 to 1.50; 2 RCTs, n = 105). There was also no significant difference in acceptability of treatment with equivocal numbers of participants leaving the studies early due to any reason (fluphenazine 36%, LPAPs 36%, RR 1.00, CI 0.88 to 1.14, 6 RCTs, n = 1532). There was no significant difference between fluphenazine and LPAPs for numbers experiencing at least one adverse effect (70% vs. 88%, respectively, RR 0.79, CI 0.58 to 1.07; 1 RCT, n = 65). However, at least one movement disorder occurred significantly more frequently in the fluphenazine group (15% vs. 10%, respectively, RR 2.11, CI 1.41 to 3.15; 3 RCTs, n = 971). In contrast, LPAPs produced significantly more sedation (20% vs. 64%, respectively, RR 0.31, CI 0.13 to 0.77; 1 RCT, n = 65). No data were available for the outcomes of death and quality of life. Adverse effects occurred significantly more frequently in the fluphenazine group: akathisia 15% vs. 6%, respectively (RR 2.28, CI 1.58 to 3.28; 5 RCTs, n = 1209); dystonia 5% vs. 2%, respectively (RR 2.66, CI 1.25 to 5.64; 4 RCTs, n = 1309); loss of associated movement 20% vs. 2%, respectively (RR 11.15, CI 3.95 to 31.47; 1 RCT, n = 338); rigor 27% vs. 12%, respectively (RR 2.18, CI 1.20 to 3.97; 2 RCTs, n = 403) and tremor 15% vs. 6%, respectively (RR 2.53, CI 1.37 to 4.68; 2 RCTs, n = 403). For other adverse effects, significantly less events occurred for for fluphenazine than for LPAPs: dizziness 8% vs. 17%, respectively (RR 0.49, CI 0.32 to 0.73; 4 RCTs, n = 1051); drowsiness 18% vs. 25%, respectively (RR 0.67, CI 0.53 to 0.86; 3 RCTs, n = 986); dry mouth 11% vs. 18%, respectively (RR 0.63, CI 0.45 to 0.89; 4 RCTs, n = 1051); nausea 4% vs. 15%, respectively (RR 0.25, CI 0.14 to 0.45; 3 RCTs, n = 986) and vomiting 3% vs. 8%, respectively (RR 0.36, CI 0.18 to 0.72; 3 RCTs, n = 986).

A Cochrane review [Abstract] 2 included 4 studies with a total of 202 subjects.

• Oral fluphenazine vs. amisulpride: There was no difference between groups for mental state using the Brief Psychiatric Rating Scale (BPRS) (MD 5.10 95% CI -2.35 to 12.55; 1 RCT, n = 57), nor was there any difference in numbers leaving the study early for any reason (RR 1.19 95% CI 0.63 to 2.28; 2 RCTs, n = 98). More people required concomitant anticholinergic medication in the fluphenazine group compared to amisulpride (RR 7.82 95% CI 1.07 to 57.26,1 RCT, n = 36). No data were reported for important outcomes including relapse, changes in life skills, quality of life or cost-effectiveness.
• Oral fluphenazine vs. risperidone: There was no difference between groups for 'clinically important response' (RR 0.67 95% CI 0.13 to 3.35; 1 RCT, n = 26) nor leaving the study early due to inefficacy (RR 1.08 95% CI 0.08 to 15.46; 1 RCT, n = 25). No data were reported data for relapse; change in life skills; quality of life; extrapyramidal adverse effects; or cost-effectiveness.
• Oral fluphenazine vs. quetiapine: There was no difference between groups for clinically important response (RR 0.62 95% CI 0.12 to 3.07; 1 RCT, n = 25), nor leaving the study early for any reason (RR 0.46 95% CI 0.05 to 4.46; 1 RCT, n = 25). No data were reported for relapse; clinically important change in life skills; quality of life; extrapyramidal adverse effects; or cost-effectiveness.
• Oral fluphenazine vs. olanzapine: There was no difference between groups for clinically important response (RR 1.33 95% CI 0.86 to 2.07; 1 RCT, n = 60), in incidence of akathisia (RR 3.00 95% CI 0.90 to 10.01; 1 RCT, n = 60) or in people leaving the study early (RR 3.00 95% CI 0.33 to 27.23; 1 RCT, n = 60). No data were reported for relapse; change in life skills; quality of life; or cost-effectiveness.