According to a new study by Finnish researchers schizophrenia patients who take an older drug for the disease are less likely to die prematurely as compared to people on newer treatments.

The drug in question here is clozapine, sold by Novartis as Clozaril, and also available generically as Leponex, Denzapine, Fazaclo, among other names.

Known as atypical antipsychotics, clozapine was introduced in the 1970s, but was banned for about a decade because of safety concerns including agranulocytosis, a potentially fatal decline in white blood cells.

In the 1980s the drug was back in the market with warnings and in most developed countries guidelines recommend the drug only as a last resort to patients after two unsuccessful trials with other antipsychotics.

Researchers examined 10 years records for 67,000 schizophrenic patients in Finland between 1996 and 2006 and compared the risk of early death for patients on clozapine to treatment with the first-generation drug perphenazine and found it had a reduced risk of 26%.

The mortality rate was found to be 41 % higher for those on Seroquel, known chemically as quetiapine; 34 % higher with Johnson & Johnson's Risperdal, or resperidone; and 13 % higher with Eli Lilly's Zyprexa, or olanzapine.

In the study published online Monday in the medical journal, Lancet, the researchers said that patients on clozapine had the lowest risk of dying, compared to other patients with schizophrenia.

"We know that clozapine has the highest efficacy of all the antipsychotics and it is now clear, after all, that it is not that risky or dangerous a treatment," said study leader Jari Tiihonen of the University of Kuopio in Finland.

"We should consider whether clozapine should be used as a first-line treatment option."

James MacCabe, a consultant psychiatrist at the National Psychosis Unit at South London and Maudsley Hospital said, "There is now a case to be made for revising the guidelines to make clozapine available to a much larger proportion of patients."

Tiihonen estimates clozapine is given to around one fifth of Finnish schizophrenia patients, but less than 5 % in the United States. MacCabe said doctors could give their schizophrenic patients clozapine after trying one other drug, as opposed to two.
 
Lydia Chwastiak of the department of psychiatry at Yale University said, “We should find ways to get more people on this medicine. If this drug can help people live longer, we need to look seriously at the barriers to using it," she said.

Tiihonen and colleagues said these restrictions should be reassessed in the light of their findings, since not using the drug may have caused thousands of premature deaths worldwide.

All the atypical antipsychotics have safety risks linked to them with evidence of increased rates of diabetes and cardiovascular disease.

The current study found no pronounced differences in heart deaths between the different atypicals, but patients on clozapine had a substantially lower risk of suicide while those on Seroquel were more likely to kill themselves.

The study was paid for by Finland's Ministry of Health and Welfare.