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FDA Approves Risperdal for Children: A Medical Advance or a Marketing Game?

By G.J. Gregory Tuesday, August 28, 2007

 

Invega is what gives. Invega is Janssen's new extended release distro of Risperdal, FDA approved 8 months ago. Having all all their bases covered with respect to Risperdal will make it much easier to market, and perhaps even get future FDA approvals on Invega.

 

I admit to cynicism where "Big Pharma" is concerned. I admit to cynicism where diagnosis of mood disorders in children is concerned. I don't claim to know much about the workings of "Big Pharma" or the workings of the FDA. But I do know when something doesn't feel right. And so much about the way Big Pharma does business is unsettling. Maybe the approval of Risperdal to treat children is all well and good, and will be an advancement in the way our kids are treated for mental disorders. Or maybe it's all a marketing game. **** cynicism again.

 

 

Read more SharePosts on the FDA's approval of Risperdal in children.

Anonymous
Ben Hansen
8/28/07 2:42pm
The studies cited by the FDA in approving Risperdal for schizophrenia and bipolar disorder in children are discussed in this FDA report:

www.fda.gov/cder/foi/esum/2007/020272s046s047,020588s006s037,021444s020s021_risperidone_clinical_BPCA.pdf

The FDA tells us the safety for schizophrenia was based on 3 studies. One was placebo-controlled (6 weeks), one low-dose controlled (8 weeks), and one open-label (6 months).

The safety for bipolar disorder was also based on 3 studies.  One was placebo-controlled (3 weeks), one was the same "long-term" open-label study mentioned above (6 months), and one was a "pharmacokinetic" study (length of study not mentioned).


WHY DID THE FDA OMIT THE LENGTH OF THIS STUDY?  THE ANSWER CAN BE FOUND IN ANOTHER FDA DOCUMENT:

http://www.fda.gov/cder/foi/esum/2007/020272s046_risperidone_clinpharm_BPCA.pdf

"The population pharmacokinetic study was done in 472 children and adolescents patients, ages 6-18. Study durations were from 12-21 days."


THERE YOU HAVE IT:

AS LITTLE AS 12 DAYS!  3 WEEKS AT THE MOST!


This allows the FDA to declare with a straight face:

"There were no reports of tardive dyskinesia in the pediatric study populations."


If you want to see the real-world incidence of tardive dyskinesia caused by Risperal in children, you won't find it ANYWHERE on the FDA web site.  But you will find a glimpse here:

http://www.psychdrugdangers.com/risperdal.html


For a real-world look at Risperdal prescribing patterns in a state Medicaid program, go here:

http://www.psychdrugdangers.com/psychotropicages0-18.html

The above web page lists all 7,327 New Jersey Medicaid Risperdal prescriptions for children under age 18 written in 2006.  The Risperdal prescriptions are sorted by age and dosage.

Note the number of children on Risperdal rises steadily until ages 11 or 12, then the numbers begin to decline.  This is NOT because the number of children on antipsychotics begins to decline.  Risperdal is the GATEWAY antipsychotic, but after a year or two the kids are often switched to a different antipsychotic (usually Seroquel or Abilify first, then Zyprexa or Geodon, and/or back to Risperdal later).
Meanwhile all sorts of other psychiatric drugs are thrown into the mix, and before you know it these kids are REALLY sick... thanks to the wonders of modern medicine, and thanks to all the doctors who write all the prescriptions, and thanks to all the taxpayers who foot the bill.


In October 2006 the FDA approved Risperdal for autistic irritability in children, based on two 8-week trials of 76 kids on Risperdal and 80 kids on placebo, detailed here:

http://www.fda.gov/MedWatch/safety/2006/Oct_PIs/RisperdalTabs_PI.pdf


Adverse Reaction     Risperdal        Placebo
Tremor                       12%              1%
Dystonia                     12%              6%
Automatism (tics)         7%              1%
Dyskinesia                    7%              0%
Parkinsonism                8%              0%


Reviewing these trial results, I have a question:

How is it that 6% of the kids on placebo develop dystonia, while only 1% develop tremor?  Can anyone out there offer possible explanations???


One more thing:

The average dose in the Risperdal autism trials was under 2mg/day.  The FDA approved Risperdal for kids over age 5, 0.5 mg/day for 15-20 kg body weight, and 1mg/day for those over 20 kg.  Look again at the New Jersey Medicaid prescriptions for Risperdal, and count the number of 2mg, 3mg and 4mg scrips.  Not to mention all the kids under age 5 on doses ranging from 0.25mg to 3mg.

When the FDA approves a psychiatric drug at a certain dose for a certain age, history shows that doctors often ignore the FDA guidelines.

On the subject of Risperdal's pediatric dosage, the author of the FDA report had this to say:


"While I believe we should certainly label the drug with the information learned from the clinical trials, and even identify target doses of 3 mg/day for pediatric schizophrenia and 2.5 mg/day for pediatric bipolar I disorder, I think it would be too restrictive to the prescriber to limit the dose to a maximum when we know that doses up to 6 mg/day were also shown to be efficacious in the same studies that demonstrated efficacy for the lower dose ranges."


Yes that's what FDA Deputy Director, Dr. Mitchell V. Mathis really said.  You can read his full report here:
www.fda.gov/cder/foi/esum/2007/020272s046s047,020588s006s037,021444s020s021_risperidone_clinical_BPCA.pdf


Ben Hansen
Traverse City, Michigan

Institute for Nearly Genuine Research
www.bonkersinstitute.org
8/28/07 3:50pm

Ben - I have to be honest, when I saw the name of your website I wasn't sure if you were on the level.  But your research is extensive and interesting. 

 

I'm a person who has a high level of distrust for the business practices of "Big Pharma", but I'm not ready to jump in and proclaim them to be totally evil.  

 

2 blogs I visit regularly that you may want to check out are <a href="http://www.furiousseasons.com/">Furious Seasons</a> and <a href="http://bipolarsoupkitchen-stephany.blogspot.com/">Soulful Sepulcher</a>.   While I don't always share their enthusiastic anti-pharma mind set, I very much respect the work they are doing, and I look to them to get a different take on psychiatric news.  Authors Philip or Stephany may be interested in seeing your research.

 

Thanks for taking the time to comment, and I look forward to your contributions in the future. 

Anonymous
Stephany
3/ 7/08 1:43pm

Hi John, I just noticed this comment when doing a google search for my blog! I would like to re phrase the "anti pharma" label, and direct it to what it represents for myself. It is pro-truth, and pro-data and anti-misleading the public with often skewed studies and data bases, sometimes key data is left out that could have saved lives such as with Paxil, Zyprexa and more. I am familiar with Ben, and most likey have those abstracts and such in my OCD>Childhood BP series, as I picked away at the evolution of the Childhood bipolar disorder evolution, I did it via researching. Where I found the oldest study was done for Risperdal by Joseph Biederman in 1999, and yet it was used in kids [like my daughter]then and long before the recent FDA approval, without long term effects known to the growing child's brain and body, this is alarming, and it still is to me quite frankly. I'd rather be considered a watch dog for safety, and ethics, because leaving out information that ultimately caused the public harm is something all of us should be concerned about with regard to Pharma. "Pharma" has not taken an oath to first do no wrong, they are an industry and a savvy one at that, which often leaves people injured as a result of misconduct. Another blog to take a look at regarding Scienfic Misconduct, is that one authored by a scientist Aubrey Blumsohn. His blog is on my blogroll and is worth reading to see how corrupt some of these practices are with leaving out data that could have changed and saved lived. Also, Seroxat Sufferers Stand Up, authored by Bob Fiddaman, is all about Paxil, and it's quite eye opening with regard to that drug as well with data "left out".

 

I appreciate very much your respect and sending people my way to take a look at my blog. As an FYI to your readers here, I take psych meds myself. I'm concerned with the dangers in the background of how these companies get the product out there, and as you can read, there is a reason Lilly is in court now for Zyprexa over at Furious Seasons.

 

Stephany, at soulful sepulcher

Anonymous
Migraineur
9/12/07 11:40pm

Here's my take: 

 

Pharmceutical companies are businesses, not charities.  They want to make a buck, that's why they exist.  But that doesn't mean they're all bad.  They reinvest a significant portion of what they make back into research for new medicines and technology that make our lives possible.  So many of us would not live the lives we lead today without medicines.  In the days of yore, we would have been institutionalized for the rest of our lives.  We're also fortunate to have as many choices as we have in medications.  It used to be Lithium.  That was it.  If it didn't work.  Too bad.  Now we have 4 FDA approved mood stabilizers and at least a dozen off-label "mood stabilizers."  

 

Personally, I'm totally grateful for extended release formulas.  They usually come with far fewer side effects and work better.  I might have to go on Depakote soon, and the only reason I'm willing to do it is because my doctor will prescribe Depakote ER so I don't have to worry so much about my hair falling out, getting fat, throwing up, and having a bad case of the shakes.

 

As for getting the same drug FDA approved for multiple conditions in multiple populations:  (1)  It's good scientific medicine to see whether our educated guesses about treatment really bear truth in reality so that we can make sure patients really are getting the best treatment possible.  Topamax is a case in point.  Lots of psychiatrists prescribe Topamax as a mood stabilizer off-label, but to date there have been no double-blind, placebo-controlled clinical trials that have found it effective.  Because these studies have been done, Topamax is now  being prescribed less by many pdocs in favor of drugs which have been proven effective.  (2)  We can't possibly expect every group to respond the same way to these medications or to have the same dosing requirements.  Isn't it better to have clinical trials trying to set standards as to what these dosing rates should be rather than letting doctors take their best guesses?  Moreover, we can't necessarily expect that children will respond to the same medications that adults will.  Let's be sure a particular med has good clinical evidence of efficacy so they are getting the best treatment possible.  It makes sense to say, "show me the data."

 

I certainly don't think pharma companies are angels, and I definitely advocate more external regulation.   I want to say that so I don't get accused of giving them a free pass or being in their back pocket.  But I do get dismayed when I see a lot of pharma bashing. 

9/13/07 8:27pm
Thanks, Migraineur.  As always, your thoughts are intelligent, well thought-out, and logical.
Anonymous
Chicagomom
9/30/07 9:42pm

Risperdal saved our family.  0.5 mg twice a day made the difference for our son.  Instead of giving me a black eye twice (resulting in temporary -- probably couple years) vision impairment -- all the behavioral techniques and emotional therapy activities actually have a chance now.  It was like a switch.  He went from tantrums and acting like a beaten animal to being a scared and immature little boy who'd been scarred by things in his past.  We can work with the latter.  Beaten dogs are so full of stress hormones, they bite the ones trying to help.  Risperdal minimized our "bites."  Of course, this was good for school too.  He didn't have to be "hypervigilant" anymore and started to act like a regular kid.  He IS a regular kid. 

 

Switched to Abilify a couple weeks ago to see if it can curb the (problemmatic) weight gain.  

<> 

<>Our son has reactive attachment disorder due to his multiple transitions in caregiving and 2 years ago our adoption of him.  He's progressing fabulously well considering -- but he definitely needs medicine.  People who suggest dietary or behavioral interventions need to realize that there are some kids for whom these strong medicines and the risks that come with them, are a very very very very good choice.  We know about the risks and want him off the meds as soon as we can.  But it won't be for a bit and frankly, having him on them for life would be better than having him lose these years of language and intellectual development.   

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By G.J. Gregory— Last Modified: 10/26/11, First Published: 08/28/07