* Study finds generic haloperidol ranks top for acute
* Researchers say findings should inform clinical guidelines
By Kate Kelland
LONDON, Aug 17 Antipsychotics are far more
effective than mood stabilisers in tackling acute manic
episodes, researchers found, and Eli Lilly's Zyprexa,
Johnson & Johnson's Risperdal and generic haloperidol
outperform the rest.
In a study published in the Lancet medical journal on
Wednesday, researchers from Britain and Italy ranked
antipsychotic drugs according to their effectiveness and said
that since current treatment guidelines don't differentiate
between the drugs, their findings could offer useful guidance
"Strikingly, some antipsychotic drugs were overall
significantly more effective than mood stabilisers," the
researchers, led by Andrea Cipriani of Verona University and
John Geddes of Oxford University, wrote in their study.
"These results have potential clinical implications that
should be considered in the development of clinical practice
Mania, defined as an "excessively raised mood", affects
around 1 percent of the population worldwide, and experts say it
tends to alternate with periods of depression. These swings
define the diagnosis of bipolar disorder.
Cipriani's team analysed the results from 68 randomised
controlled trials involving more than 16,000 participants from
January 1980 to November 2010 to compare the most common drugs
used to treat acute mania in adults.
They found that haloperidol, Zyprexa and Risperdal were the
most effective antimanic drugs and said they "should be
considered as among the best of the available options for the
treatment of manic episodes".
Zyprexa has been one of Elli Lilly's top-selling drugs, but
is set to lose its valuable marketing exclusivity in the United
States in October.
Haloperidol also had the highest number of significant
differences in head-to-head comparisons, coming out better than
Otsuka Pharmaceutical's Abilify, known generically as
aripiprazole;` carbamazepine, sold as Carbatrol by Shire
and Tegretol by Novartis ; valproate, sold by Abbott
Laboratories as Depakine and Sanofi-Aventis as
Epilim; Lundbeck's and Merck's asenapine.
It also ranked higher than Pfizer's Neurontin or
gabapentin; lamotrigine, sold by GlaxoSmithKline as
Lamictal; AstraZeneca's Seroquel or quetiapine; J&J's
Topamax or topiramate and several other generic treatments,
including lithium, the researchers said.
Risperdal, Zyprexa and Seroquel were least likely to result
in patients deciding to stop their treatment and were better
than many mood stabilisers, the study found.
In a commentary on the study also published in the Lancet,
Michael Berk of Deakin University, Australia, and Gin Malhi at
the Royal North Shore Hospital in Sydney said its findings were
likely "to attract much interest and have a substantial effect
both on clinical practice guidelines and real-world treatment".
But they added that while haloperidol "seems to have won the
race for pole position in the treatment of acute mania",
management of these episodes is not always the primary treatment
"Instead, the main goals of treatment are attention to
long-term mood stability and prophylaxis," they said, suggesting
that haloperidol may not always be best in these circumstances.
(Editing by Will Waterman)