Oral antipsychotics for the treatment of schizophrenia: heterogeneity in efficacy and tolerability should drive decision-making.

BACKGROUND

Antipsychotic medications are conventionally divided into two groups: First-generation and second-generation antipsychotics (FGAs and SGAs). There is a disagreement about the role of these two groups in the treatment of schizophrenia.

OBJECTIVE

To analyze the reasons for the disagreement and to propose a resolution that would improve the treatment of schizophrenia.

METHOD

An overview of individual SGAs and several FGAs involved in the current disagreement is presented. Effectiveness studies that contributed to the SGAs versus FGAs disagreement are assessed, and meta-analyses of SGAs and FGAs are reviewed.

RESULTS/CONCLUSIONS: Efficacy variations within SGAs and FGAs result in overlaps between the two groups. Regarding safety, FGAs elicit more extrapyramidal side effects and tardive dyskinesia as well as prolactin elevations than SGAs, whereas some SGAs tend to be associated with more weight gain and disturbances in lipid and glucose regulation than FGAs. However, there are again considerable differences between individual agents and overlaps between the two groups in terms of side effects. The classification of antipsychotics into the two groups is no longer useful. The treatment selection for an individual patient should focus on the suitability of an individual antipsychotic for that patient rather than on the group membership of the drug.