Study may prompt rethink on schizophrenia drugs

* Fewer deaths with clozapine than newer drugs

* Call to consider cheap generic as first-line treatment

* Finnish study fuels debate on atypical antipsychotics

By Ben Hirschler

LONDON, July 13 (Reuters) - Schizophrenia patients given a cheap older drug are less likely to die prematurely than people on newer treatments, despite the older product's well-known adverse side effects, Finnish researchers said on Monday.

The finding may lead to wider use of clozapine -- sold by Novartis (NOVN.VX) as Clozaril, but also available as a generic -- instead of newer drugs like AstraZeneca's (AZN.L) Seroquel, the current market leader.

Clozapine was the first of a new generation of schizophrenia drugs, known as atypical antipsychotics. But its use has been restricted by health authorities because of safety concerns and patients taking it require regular blood tests.

Despite this, an analysis of 10 years' records for 67,000 patients in Finland found that, compared to treatment with the first-generation drug perphenazine, the risk of early death for patients on clozapine was reduced by 26 percent.

By contrast, mortality risk was 41 percent higher for those on Seroquel, known chemically as quetiapine; 34 percent higher with Johnson & Johnson's (JNJ.N) Risperdal, or resperidone; and 13 percent higher with Eli Lilly's (LLY.N) Zyprexa, or olanzapine.

"We know that clozapine has the highest efficacy of all the antipsychotics and it is now clear, after all, that it is not that risky or dangerous a treatment," study leader Jari Tiihonen of the University of Kuopio said in a telephone interview.

"We should consider whether clozapine should be used as a first-line treatment option."

THOUSANDS OF PREMATURE DEATHS

Tiihonen estimates clozapine is given to around one fifth of Finnish schizophrenia patients, but less than 5 percent in the United States.

Clozapine's side effects include agranulocytosis, a potentially fatal decline in white blood cells, and current rules stipulate the drug can only be used after two unsuccessful trials with other antipsychotics.