Olanzapine vs haloperidol in geriatric schizophrenia: Analysis of data from a double-blind controlled trial

J. S. Kennedy, D. Jeste, C. J. Kaiser, S. Golshan, G. A. Maguire, G. Tollefson, T. Sanger, F. P. Bysmaster, B. J. Kinon, M. Dossenbach, J. A. Gilmore, Alan Breier

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Objectives: To compare the six-week clinical response and safety profile of schizophrenia patients, age ≥60 years, receiving olanzapine (OLZ) vs haloperidol (HAL) in a double blind, randomized trial. Methods: Double-blind data on patients age ≥60 randomized to 5 mg/d OLZ (n = 83) or 5 mg/d HAL (n = 34) (Week 1) then flexibly dosed to 5-20 mg/d over six weeks, with a 48-week extension for responders, were analyzed post-hoc. Efficacy indices included the PANSS Total and PANSS Psychosis Core Total (PPCT). Safety measures included the Simpson-Angus Scale (SAS), Barnes Akathisia Scale (BAS), Abnormal Involuntary Movement Scale (AIMS), treatment-emergent adverse events, and laboratory values. Mixed model, repeated measures (MMRM) analyses were applied to all continuous data measured at each visit. Continuous data recorded only at phase completion or termination were analyzed with a fixed effect last observation carried forward (LOCF) model. Frequencies of categorical response data were analyzed using Fisher's exact methods. Differences were tested for significance at Week 6 using a two-sided alpha value of 0.05. Results: HAL group (n = 34; age range 60-80) received a mean modal dose 9.4 mg/d while OLZ group (n = 83; age range 60-86) received a mean modal dose 11.9 mg/d. At Week 6, OLZ was superior to HAL on both the PANSS Total (p = 0.015) and PPCT (p = 0.043). Considering safety, OLZ was superior to HAL for the SAS and BAS (p <0.001; p <0.001). No spontaneous adverse event occurred more frequently with OLZ than with HAL. In patients never receiving adjunct anticholinergic therapy, no significant differences were present for anticholinergic-like side effects including blurred vision, dry mouth, constipation, or urinary difficulties. Conclusions: In elderly schizophrenia patients, olanzapine was more efficacious and better tolerated for extrapyramidal signs than was haloperidol. Olanzapine was equivalent to haloperidol for anticholinergic-like side effects when corrected for anticholingergic agents.

Original languageEnglish (US)
Pages (from-to)1013-1020
Number of pages8
JournalInternational Journal of Geriatric Psychiatry
Volume18
Issue number11
DOIs
StatePublished - Nov 2003
Externally publishedYes

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olanzapine
Haloperidol
Geriatrics
Schizophrenia
Cholinergic Antagonists
Psychomotor Agitation
Safety
Psychotic Disorders
Constipation
Double-Blind Method
Mouth

Keywords

  • Anticholinergic
  • Double-blind trial
  • Efficacy
  • Elderly
  • Geriatric
  • Haloperidol
  • Olanzapine
  • Safety
  • Schizophrenia

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Psychiatry and Mental health

Cite this

Olanzapine vs haloperidol in geriatric schizophrenia : Analysis of data from a double-blind controlled trial. / Kennedy, J. S.; Jeste, D.; Kaiser, C. J.; Golshan, S.; Maguire, G. A.; Tollefson, G.; Sanger, T.; Bysmaster, F. P.; Kinon, B. J.; Dossenbach, M.; Gilmore, J. A.; Breier, Alan.

In: International Journal of Geriatric Psychiatry, Vol. 18, No. 11, 11.2003, p. 1013-1020.

Research output: Contribution to journalArticle

Kennedy, JS, Jeste, D, Kaiser, CJ, Golshan, S, Maguire, GA, Tollefson, G, Sanger, T, Bysmaster, FP, Kinon, BJ, Dossenbach, M, Gilmore, JA & Breier, A 2003, 'Olanzapine vs haloperidol in geriatric schizophrenia: Analysis of data from a double-blind controlled trial', International Journal of Geriatric Psychiatry, vol. 18, no. 11, pp. 1013-1020. https://doi.org/10.1002/gps.1007
Kennedy, J. S. ; Jeste, D. ; Kaiser, C. J. ; Golshan, S. ; Maguire, G. A. ; Tollefson, G. ; Sanger, T. ; Bysmaster, F. P. ; Kinon, B. J. ; Dossenbach, M. ; Gilmore, J. A. ; Breier, Alan. / Olanzapine vs haloperidol in geriatric schizophrenia : Analysis of data from a double-blind controlled trial. In: International Journal of Geriatric Psychiatry. 2003 ; Vol. 18, No. 11. pp. 1013-1020.
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AU - Jeste, D.

AU - Kaiser, C. J.

AU - Golshan, S.

AU - Maguire, G. A.

AU - Tollefson, G.

AU - Sanger, T.

AU - Bysmaster, F. P.

AU - Kinon, B. J.

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N2 - Objectives: To compare the six-week clinical response and safety profile of schizophrenia patients, age ≥60 years, receiving olanzapine (OLZ) vs haloperidol (HAL) in a double blind, randomized trial. Methods: Double-blind data on patients age ≥60 randomized to 5 mg/d OLZ (n = 83) or 5 mg/d HAL (n = 34) (Week 1) then flexibly dosed to 5-20 mg/d over six weeks, with a 48-week extension for responders, were analyzed post-hoc. Efficacy indices included the PANSS Total and PANSS Psychosis Core Total (PPCT). Safety measures included the Simpson-Angus Scale (SAS), Barnes Akathisia Scale (BAS), Abnormal Involuntary Movement Scale (AIMS), treatment-emergent adverse events, and laboratory values. Mixed model, repeated measures (MMRM) analyses were applied to all continuous data measured at each visit. Continuous data recorded only at phase completion or termination were analyzed with a fixed effect last observation carried forward (LOCF) model. Frequencies of categorical response data were analyzed using Fisher's exact methods. Differences were tested for significance at Week 6 using a two-sided alpha value of 0.05. Results: HAL group (n = 34; age range 60-80) received a mean modal dose 9.4 mg/d while OLZ group (n = 83; age range 60-86) received a mean modal dose 11.9 mg/d. At Week 6, OLZ was superior to HAL on both the PANSS Total (p = 0.015) and PPCT (p = 0.043). Considering safety, OLZ was superior to HAL for the SAS and BAS (p <0.001; p <0.001). No spontaneous adverse event occurred more frequently with OLZ than with HAL. In patients never receiving adjunct anticholinergic therapy, no significant differences were present for anticholinergic-like side effects including blurred vision, dry mouth, constipation, or urinary difficulties. Conclusions: In elderly schizophrenia patients, olanzapine was more efficacious and better tolerated for extrapyramidal signs than was haloperidol. Olanzapine was equivalent to haloperidol for anticholinergic-like side effects when corrected for anticholingergic agents.

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