Amisulpride and olanzapine combination treatment versus each monotherapy in acutely ill patients with schizophrenia in Germany (COMBINE): a double-blind randomised controlled trial
RCT (n=328) found amisulpiride plus olanzapine provided a greater improvement in negative symptoms at 8 weeks than olanzapine plus placebo (Positive and Negative Syndrome Scale score difference-24.1, p=0.049), but not amisulpiride plus placebo (-25.2, p=0.095).
Source:
The Lancet Psychiatry
SPS commentary:
After 8 weeks and 16 weeks, sexual dysfunction, weight, and waist circumference increase were significantly higher for patients receiving amisulpride plus olanzapine than for those receiving amisulpride plus placebo, with no differences in serious adverse events.
A related commentary discusses this research and implications but notes clinicians should carefully consider whether antipsychotic co-initiation is necessarily the most beneficial first-line treatment for patients with acute schizophrenia. In general, co-initiating two or more medications hampers clinicians trying to evaluate the efficacy and tolerability of each component medication. A guiding principle of drug prescription is that simplicity is best.
Although this study and other research has shown efficacy for antipsychotic combinations, clinicians should first attempt a simple prescription (ie, antipsychotic monotherapy) and carefully consider the balance of risks and benefits before implementing antipsychotic combination therapy.