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A commentary on the efficacy of olanzapine for the treatment of schizophrenia: the past, present, and future

Authors Citrome L, McEvoy JP, Todtenkopf MS, McDonnell D, Weiden PJ

Received 19 March 2019

Accepted for publication 20 August 2019

Published 5 September 2019 Volume 2019:15 Pages 2559—2569

DOI https://doi.org/10.2147/NDT.S209284

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Roger Pinder


Leslie Citrome1, Joseph P McEvoy2, Mark S Todtenkopf3, David McDonnell4, Peter J Weiden3

1Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA; 2Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA, USA; 3Alkermes, Inc., Waltham, MA, USA; 4Alkermes Pharma Ireland Ltd., Dublin, Ireland

Correspondence: Leslie Citrome 11 Medical Park Drive, Suite 106, Pomona, NY 10970, USA
Tel +1 845 362 2081
Email citrome@cnsconsultant.com

Abstract: Olanzapine is a second-generation atypical antipsychotic with proven efficacy for the treatment of schizophrenia. Approved in 1996, olanzapine is one of the most studied antipsychotics, resulting in a considerable amount of clinical data across diverse patient populations. Despite the fact that olanzapine is associated with a known risk of metabolic side effects, including weight gain, many clinicians continue to prescribe olanzapine for the treatment of schizophrenia with the expectation of additional therapeutic antipsychotic efficacy relative to other first-line atypical antipsychotics. The goal of this narrative is to revisit the role of oral olanzapine in the management of patients with schizophrenia, including those with recently diagnosed schizophrenia (“first-episode”), those with an established schizophrenia diagnosis who experience acute exacerbations, those receiving long-term antipsychotic treatment as a maintenance intervention, and those with suboptimal response to antipsychotic treatment, including treatment resistance. Collectively, data from published literature support the favorable efficacy of olanzapine compared with other first- and second-generation antipsychotics, including lower rates of treatment discontinuation and clinically meaningful improvements in the symptoms of schizophrenia. The development of antipsychotic medications with the favorable efficacy of olanzapine, but with reduced weight gain, could address a major unmet need in the treatment of schizophrenia.

Keywords: antipsychotic, efficacy, metabolic dysregulation, weight gain

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