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| |  CINP: Clozapine Reduces Suicidality in Schizophrenia By Heather Pengelley MONTREAL, QC -- June 26, 2002 -- The International Suicide Prevention Trial (Intersept) has found that clozapine is significantly more effective than olanzapine in preventing suicide attempts and hospitalizations to prevent suicide in patients with schizophrenia and schizoaffective disorder. Physicians only need to treat 12 patients with clozapine to show an advantage over olanzapine, said Dr. Herbert Meltzer, of Vanderbilt University, Nashville, Tennessee, United States, on behalf of Intersept investigators. The findings of this two-year, prospective, randomised, multicentre, international trial in 980 patients were presented at the 23rd Congress of the Collegium Internationale Neuro-Psychopharmacologicum (CINP). Suicide remains the leading cause of death in schizophrenia patients younger than 35. About half of patients with schizophrenia and schizoaffective disorder attempt suicide in their lifetime; past surveys indicate that about 10 percent succeed. Intersept studied how these drugs affected suicide risk, as measured by time to a suicide attempt or hospitalization due to imminent suicide risk, as determined by a Suicide Monitoring Board, and the occurrence or worsening of suicidality, as determined by a blinded psychiatrist. Clozapine significantly reduced both end points vs. olanzapine (p=0.03). The primary efficacy analysis found a lower hazard ratio of 0.76 (95 percent CI 0.58-0.98) for suicide attempts or hospitalizations to prevent suicide in clozapine-treated patients. This finding suggests that clozapine-treated patients have 24 percent less risk of suicide attempts or hospitalizations than patients on olanzapine. The number of patients who experienced at least one suicide attempt or hospitalization for suicide risk was significantly lower for clozapine vs. olanzapine (20.8 percent vs. 28.8 percent, p=0.0047). Intersept investigators recommend clozapine as first-line therapy in patients with schizophrenia and schizoaffective disorder who are at high risk of suicidality. Using clozapine instead of olanzapine in high-risk patients should lead to an 8 percent reduction in the burgeoning healthcare costs for suicidality, they surmised. Patients with schizophrenia or schizoaffective disorder were enrolled in Intersept if they had attempted suicide or been hospitalized for imminent suicide risk within the previous three years; had moderate to severe suicide ideation and depression within the previous week; or had moderate to severe suicide ideation and command hallucinations within the previous week. Of 980 patients, 671 completed the study. Pill counts found that 95 percent of patients were compliant with therapy. The mean dose of clozapine was 272.2±156.01 mg/day. For olanzapine, the mean dose was 16.6±6.39 mg/day. Patients in both groups had similar demographic and background characteristics. Reasons for discontinuation did not differ significantly between groups. Among those who discontinued due to adverse effects, 8.4 percent had received clozapine, while 6.7 percent had received olanzapine.
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