Atypical antipsychotic agents; Peas in a pod or chalk and cheese?
1 IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong 3220, Australia
2 Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville 3052, Victoria, Australia
3 Barwon Health and the Geelong Clinic, Swanston Centre, Geelong 3220, Victoria, Australia
4 Florey Institute for Neuroscience and Mental Health, Kenneth Myer Building, Royal Parade, Parkville, Australia
5 Department of Psychiatry, University of Melbourne, Parkville, 3052, Australia
6 Bipolar Clinic and Research Program, Massachusetts General Hospital, Harvard Medical School, 50 Staniford Street, Boston 02114-2517, MA, USA
7 Department of Psychiatry, University of British Columbia, Vancouver V6T 1Z3, BC, Canada
BMC Medicine 2014, 12:126 doi:10.1186/s12916-014-0126-1Published: 1 August 2014
With escalating health expenditure and a shrinking purse, there is increased focus on the cost efficacy of still patented versus generic medications in general, and for atypical antipsychotics in particular. In a recent BMC Medicine article, Godman and colleagues presented data indicating poor uptake of the off patent atypical antipsychotic risperidone, arguing for authorities to mandate its greater use. This is under the assumption of clinical equivalence of atypical antipsychotics. This commentary argues that there are clinically meaningful differences between atypical antipsychotics and important inter-individual heterogeneity in clinical response and tolerability. Access to a broad range of atypical antipsychotics enables clinicians to tailor care, taking consideration of differential efficacy and adverse effects profile in order to meet the needs of individual patients with improved real world effectiveness of treatment. Restriction of agent choice risks detracting from optimal clinical care, with possible poorer outcomes and greater costs of care. A balance between encouraging use of cheapest in class agent and allowing access to various atypical agents for tailored care is likely to produce optimal health outcomes.