Background:
To examine potential differences in efficacy and safety of treatment with olanzapine in patients with schizophrenia of white and black descent.
Methods:
A post-hoc, pooled analysis of 6 randomized, double-blind trials in the treatment of schizophrenia, schizophreniform disorder, or schizoaffective disorder compared white (N=605) and black (N=375) patients treated with olanzapine (5 to 20 mg/day) for 24 to 28 weeks. Efficacy measurements included the Positive and Negative Syndrome Scale (PANSS) total score; and positive, negative, and general psychopathology scores; and the Clinical Global Impression of Severity (CGI-S) scores at 6 months. Safety measures included differences in the frequencies of adverse events along with measures of extrapyramidal symptoms, weight, glucose, and lipid changes over time.
Results:
51% of black patients and 45% of white patients experienced early study discontinuation (P=.133). Of those who discontinued, significantly more white patients experienced psychiatric worsening (P=.002) while significantly more black patients discontinued for reasons other than efficacy or tolerability (P=.014). Discontinuation for intolerability was not different between groups (P=.320). For the estimated change in PANSS total score over 6 months, there was no significant difference in efficacy between white and black patients (P=.928), nor on the estimated PANSS positive (P=.435), negative (P=.756) or general psychopathology (P=.165) scores. Overall, there was no significant difference in the change in CGI-S score between groups from baseline to endpoint (P=.979). Weight change was not significantly different in white and black patients over 6 months (P=.127). However, mean weight change was significantly greater in black versus white patients at Weeks 12 and 20 only (P=.028 and P=.026, respectively). Additionally, a significantly greater percentage of black patients experienced clinically significant weight gain ([greater than or equal to]7%) at anytime compared to white patients (36.1% vs. 30.4%, P=.021). Changes across metabolic parameters (combined fasting and random lipids and glucose) were also not significantly different between groups, with the exception of a greater categorical change in total cholesterol from borderline to high among white subjects and a categorical change from normal to low in high density lipoprotein (HDL) cholesterol among white males.
Conclusions:
The findings did not demonstrate overall substantive differences in efficacy or safety between white and black patients diagnosed with schizophrenia or related disorders treated with olanzapine. However, a significantly greater percentage of black patients (36.1%) experienced clinically significant weight gain compared to white patients (30.4%).