The Pharmaceutical Journal
Vol 269 No 7216 p392-394
21 September 2002

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Letters to the Editor

Antipsychotics

Are olanzapine and zotepine comparable?

From Dr P. D. Brash

In the recent original paper (PDF 70K), "Is olanzapine clinically effective? A naturalistic outcome survey in two hospital settings" by Gilchrist et al (PJ, 17 August, pp222–5) there is a significant omission in the discussion section.

The authors say that there are no naturalistic outcome data of which they are aware available for other new antipsychotic drugs. In fact there is a large naturalistic study of the atypical antipsychotic zotepine involving 255 patients over 12 months.¹ In a population similar to that reported by Gilchrist et al (based on baseline Clinical Global Impression scores) the reduction in mean Brief Psychiatric Rating Scale score (all patients) was reduced from 51.7 to 40.8 (21.1 per cent), and in the subgroup who continued beyond six months was reduced by 29.6 per cent. The CGI score was statistically better from two weeks with a mean improvement of 0.9 (all patients), and 64 per cent of all patients showed an improvement. With regard to compliance, 54.5 per cent of patients were still taking zotepine at six months, 45.1 per cent at 12 months at a modal dose of 150mg. Improvements in negative symptoms and a low incidence of extrapyramidal side effects are also reported, consistent with other published data on zotepine.

Although these studies do not allow direct comparison, it is interesting to note that zotepine and olanzapine appear to show comparable efficacy in a naturalistic setting.

Peter Brash
UK Medical Director
Orion Pharma (UK)

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