Aripiprazole or Risperidone for First-Episode Schizophrenia?
Choosing an antipsychotic agent for patients with first-episode psychosis is difficult without any past patient experiences with antipsychotics to guide the decision. Thus, research findings on first-episode patients are especially crucial.
A study recently published in Schizophrenia Bulletin compared aripiprazole and risperidone in 198 patients aged 15–40 years with schizophrenia spectrum disorders. The study is the first large-scale double-masked randomized comparison with first-episode patients, researchers said, and its conclusions highlight several factors that clinicians should consider when making a prescribing decision for a first-episode patient.
Patients were randomized to receive either 5–30 mg/d of aripiprazole or 1–6 mg/d of risperidone. They were then followed for 12 weeks.
Results indicated that time to response was not different in patients in the aripiprazole and risperidone groups, nor was the positive symptom response rate different (62.8% vs 56.8%).
However, patients receiving aripiprazole showed more improvement in negative symptoms than those receiving risperidone, though they also had more severe akathisia. Aripiprazole performed better with total low-density lipoprotein cholesterol, fasting glucose, and prolactin levels, yet body mass index was the same for aripiprazole and risperidone. According to post-hoc analysis, aripiprazole was better at improving depressed mood.
“Overall, if the potential for akathisia is a concern, low-dose risperidone as used in this trial maybe a preferred choice over aripiprazole. Otherwise, aripiprazole would be the preferred choice over risperidone in most situations based upon metabolic outcome advantages and some symptom advantages within the context of similar positive symptom response between medications,” the researchers concluded.
In addition, the study’s authors stressed that clinicians should follow guideline recommendations and closely monitor patients for side effects, particularly metabolic changes that can occur even when patients’ BMI remains unchanged.
—Lauren LeBano
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