Ziprasidone and risperidone equally efficacious for treatment of acute exacerbation of schizophrenia or schizoaffective disorder

Ziprasidone (Geodon, Pfizer) and risperidone (Risperdal, Janssen) are equally efficacious in the treatment of patients with acute exacerbation of schizophrenia and schizoaffective disorder, with ziprasidone demonstrating a lower movement disorder burden and less effect on prolactin concentrations and weight than risperidone.

In a randomized, double-blind, multicenter, parallel-group study, researchers assigned 296 patients with a DSM-III-R acute exacerbation of schizophrenia or schizoaffective disorder to ziprasidone 40 to 80 mg bid (n=149) or risperidone 3 to 5 mg bid (n=147) for 8 weeks to measure efficacy and safety levels.

At Week 1, patients were treated with ziprasidone 40 mg bid, with treatment adjusted weekly thereafter in 20-mg bid increments, keeping within a range of 80 to 160 mg/d. Risperidone was titrated from 1 mg bid (Day 1) to 3 mg bid (Days 3 to 7) during Week 1, and then adjusted at weekly intervals in 1-mg increments to a maximum of 5 mg bid. Over the August 1995 to January 1997 study period, approximately 37% and 29% of the ziprasidone and risperidone groups, respectively, discontinued treatment.

The mean Movement Disorder Burden (MDB) score was significantly higher for risperidone- than for ziprasidone-treated patients (0.35 vs 0.20; P=.015). More patients experienced a movement disorder adverse event in the risperidone group (54, 36.7%) than in the ziprasidone group (44, 29.5%).

Treatment-related adverse events occurred in 87 (58.4%) and 92 (62.6%) ziprasidone- and risperidone-treated patients, respectively. Adverse events rates identified in ≥10% of patients were similar between groups, except for a higher rate of insomnia in the ziprasidone group and akathisia in the risperidone group.

Serum prolactin concentration elevations were more consistent in both men and women taking risperidone (men, 38.1 ng/mL; women, 81.7 ng/mL) than in those taking ziprasidone (men, 14.0 ng/mL; women, 23.2 ng/mL). Although no relevant changes in vital signs from baseline in median values were observed in either group, 7 patients (4 risperidone, 3 ziprasidone) at last observation experienced irregularities.

Ziprasidone demonstrated a less clinically important effect on weight (8.2% experienced weight increase, 7.4% experienced weight decrease) than with risperidone (16.0% experienced weight increase, 2.4% experienced weight decrease).

SOURCE Addington DE, Pantelis C, Dineen M, Benattia I, Romano SJ. Efficacy and tolerability of ziprasidone versus risperidone in patients with acute exacerbation of schizophrenia or schizoaffective disorder: an 8-week, double-blind, multicenter trial. J Clin Psychiatry. 2004;65:1624-1633.