Are new drugs for schizophrenia better than old ones?

摘要

The comprehensive meta-analysis by Stefan Leucht and colleagues arrives at some valuable conclusions, but also reveals major shortcomings. First, the statement that second-generation antipsychotics are not superior to first-generation antipsychotics, referring to negative symptoms in general, does not seem to be correct. The studies included are mainly approval studies for the indication of schizophrenia, "paranoid or undifferentiated subtype". That means that most patients included will have had prominent positive symptoms. Thus, we would expect patients with so-called secondary negative symptoms in these studies, which tend to improve together with positive symptoms. To our knowledge there is only one study dealing with primary negative symptoms in schizophrenia. Furthermore, the maximum duration of 80% of the studies included is 12 weeks. This period is much too short for serious assessment, especially for negative syndromes, since negative symptoms show improvement only after about 6 months.