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First- and Second-Generation Antipsychotics for Children and Young Adults

Slide: 26 of 43

Results of Comparative Effectiveness Studies: FGAs Versus SGAs

For pediatric use, first-generation antipsychotics (FGAs) have been compared directly with second-generation antipsychotics (SGAs) for treatment effects in pervasive developmental disorders (PDDs) such as autism.

Haloperidol and olanzapine were compared for effects on autistic symptoms, evaluated using the Comprehensive Psychopathological Rating Scale (CPRS). One study of 12 participants showed that anger and hyperactivity factors were reduced only in the olanzapine group (p ≤ 0.05); the strength of evidence for this result is low. Haloperidol and risperidone were compared for effects on autistic symptoms, evaluated with the Aberrant Behavior Checklist (ABC) and the Clinical Global Impression (CGI) scale. One study of 30 participants showed that behavior, impulsivity, and language skills improved to a greater degree with risperidone (p ≤ 0.05); the strength of evidence for this result is low.

FGAs have been compared directly to SGAs for treatment effects on schizophrenia. Haloperidol was compared with clozapine, olanzapine, and risperidone. In a meta-analysis of 3 studies of 71 participants, the score on the Brief Psychiatric Rating Scale (BPRS) is 11.44 points lower with SGAs (the statistically valid range, defined by the 95-percent confidence interval [95% CI], is 3.52 to 19.35 points lower).

In a meta-analysis of 3 studies of 87 participants, the Clinical Global Impression-Improvement (CGI-I) scale score is 0.76 points lower with SGAs (the statistically valid range is 0.26 to 1.25 points lower). In a meta-analysis of 2 studies of 27 participants, no statistically significant difference in the Positive and Negative Syndrome Scale (PANSS) score is found (the statistically valid range is from 33.85 points lower to 14.08 points greater). The strength of evidence is low for each of these three results.

For comparisons of FGAs and SGAs in the treatment of Tourette’s syndrome, the evidence is insufficient to permit conclusions about effect size or statistical significance.