The Slap Heard 'Round the World: Atypical Antipsychotics for Alzheimer's

Atypical antipsychotics just got slapped hard. A new study in the Archives of General Psychiatry delivered sizable blow to these medications by finding that they yielded no clinical benefit over "watchful waiting" (placebo) in treating dementia, while all atypical antipsychotics studies were associated with higher costs.

Olanzapine (Zyprexa) did particularly poorly. Patients taking Zyprexa had higher costs, yet their activities of daily living (personal care, doing chores, household activities, etc.) score was significantly worse than patients taking placebo. Patients taking risperidone (Risperdal) and quetiapine (Seroquel) also scored worse than patients receiving placebo on this measure, though Zyprexa patients had the lowest overall scores. In addition, Zyprexa patients were rated as significantly more dependent by their caregivers than patients taking placebo. Here's what the authors said:

The secondary finding that patients taking olanzapine scored worse on the activities of daily living measure than patients treated with watchful waiting most likely represents the greater level or combination of sedation, gait disturbances, and behaviorally inhibiting adverse effects with this drug.

Ouch. You may recall that this class of medications was marketed off-label for dementia. For example, see a prior post, complete with links to documentaton of how Lilly pushed Zyprexa for dementia/Alzheimer's. Let's not forget that antipsychotic meds are linked to that teeny little side effect known as death in older patients with dementia as well.

Let's see if I have this straight: A large number of dementia patients are placed on expensive drugs that have scant evidence of efficacy, and are linked to an increased rate of death. Uh, does this strike anybody else as W-R-O-N-G?

What Do Academics Say? Surely, academic psychiatrists are aware of the fact that atypical antipsychotics are poorly supported in treating dementia. After all, they are highly educated, objective scientists and they will pass along the objective evidence to the world. That's why they write things like this in the journal Current Psychiatry:

SGAs [atypical antipsychotics] remain the first therapeutic option for psychosis and agitation in Alzheimer’s patients.

Phew, good thing people can turn to objective, unbiased scientists for a realistic appraisal of the research literature, right? I think a Golden Goblet nomination can safely be issued to the authors of the above piece in Current Psychiatry -- you really should read my earlier post on the topic -- the article is mind-bogglingly bad.