Comparative Efficacy of Risperidone and Clozapine in the Treatment of Patients With Refractory Schizophrenia or Schizoaffective Disorder: A Retrospective Analysis
J Clin Psychiatry 2000;61(7):498-504
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Clozapine is effective in up
to 60% of patients with refractory schizophrenia, whereas the
efficacy of risperidone remains unknown. This retrospective study
examined the relative efficacy of these drugs in chronically
institutionalized patients refractory to conventional
Method: A total of 24 patients who at
different time periods had received adequate trials of both
clozapine and risperidone and met our inclusion criteria for
minimum dose and duration of each trial were included; for
clozapine, a minimum dose of 300 mg/day had to be maintained for
at least 12 weeks, and for risperidone, a minimum dose of 6
mg/day for at least 6 weeks. Information obtained from systematic
retrospective chart review was blindly rated by 2 psychiatrists
using the 7-point Clinical Global Impressions-Improvement (CGI-I)
scale on overall clinical state and along specific symptom
domains of positive symptoms, negative symptoms, and aggressive
Results: The mean ± SD dose was 520 ±
94 mg/day for clozapine and 7.5 ± 2.2 mg/day for risperidone.
Fourteen patients (58%) were classified as responders to
clozapine, while 6 (25%) responded to risperidone (CGI-I score of
1 or 2); on specific symptom domains, response rates to clozapine
were 38% (9/24) on positive symptoms, 29% (7/24) on negative
symptoms, and 71% (12/17) on aggressive behavior. For
risperidone, response rates were 17% (4/24) on positive symptoms,
8% (2/24) on negative symptoms, and 41% (7/17) on aggressive
Conclusion: The results of this study
support the utility of first giving a risperidone trial in a
treatment algorithm for refractory patients because of its better
risk/benefit profile compared with clozapine. Clozapine, however,
remains our gold standard in the management of these patients.