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Background The treatment of schizophrenia with multiple antipsychotic drugs is common, but the benefits and risks are not known.
Methods In a randomized, double-blind study, we evaluated patients with schizophrenia and a poor response to treatment with clozapine. The patients continued to take clozapine and were randomly assigned to receive eight weeks of daily augmentation with 3 mg of risperidone or with placebo. This course of treatment was followed by an optional 18 weeks of augmentation with risperidone. The primary outcome was reduction in the total score for severity of symptoms on the Positive and Negative Syndrome Scale (PANSS). The secondary outcomes included cognitive functioning.
Results A total of 68 patients were randomly assigned to treatment. In the double-blind phase, the mean total score for the severity of symptoms decreased from baseline to eight weeks in both the risperidone and the placebo groups. There was no statistically significant difference in symptomatic benefit between augmentation with risperidone and placebo: 9 of 34 patients receiving placebo and 6 of 34 receiving risperidone responded to treatment (P=0.38). The mean difference in the change in PANSS scores from baseline to eight weeks between those receiving risperidone and those receiving placebo was 0.1 (95 percent confidence interval, –7.3 to 7.0). The verbal working-memory index showed a small decline in the risperidone group and a small improvement in the placebo group (P=0.02 for the comparison between the two groups in the change from baseline). The increase in fasting blood glucose levels was mildly greater in the risperidone group than in the placebo group (16.2 vs. 1.8 mg per deciliter [0.90 vs. 0.10 mmol per liter], P=0.04). The incidence and severity of other side effects did not differ between the two groups.
Conclusions In this short-term study, the addition of risperidone to clozapine did not improve symptoms in patients with severe schizophrenia. (ClinicalTrials.gov number, NCT00272584
[ClinicalTrials.gov]
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Source Information
From the Department of Psychiatry (W.G.H., R.W., G.W.M.) and the Division of Pharmaceutics and Biopharmaceutics (K.W.), University of British Columbia, Vancouver, Canada; Department of Psychology, Simon Fraser University, Burnaby, B.C., Canada (A.E.T.); Department of Psychiatry, University of Hong Kong, Hong Kong, China (E.Y.H.C.); Department of Psychology, Sun Yat-Sen University, Guangzhou, China (R.C.K.C.); Castle Peak Hospital, Hong Kong, China (J.O.Y.W.); Department of Psychiatry, Saarland University, Homburg, Germany (A.B., P.F.), Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (E.P.-C., P.J.M.); Department of Psychiatry, University of Montreal, Montreal (E.S.); and Riverview Hospital, Port Coquitlam, B.C., Canada (R.P.).
Address reprint requests to Dr. Honer at the Centre for Complex Disorders and the Department of Psychiatry, University of British Columbia, Vancouver General Hospital Research Pavilion, 828 W. 10th Ave., Suite 211, Vancouver, BC V5Z 1L8, Canada, or at honer{at}interchange.ubc.ca.
Related Letters:
Clozapine Alone versus Clozapine and Risperidone for Refractory Schizophrenia
Grass G., Hellmich M., Leweke F. M., Meltzer H. Y., Ya
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olu A. E. A., Akdede B. B. K., Gerson S. L., Honer W. G., Thornton A. E., MacEwan G. W., Davis J. M.
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N Engl J Med 2006;
354:1846-1848, Apr 27, 2006.
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