Medication Study: New Hope?

Olanzapine helped trichotillomania in small study.(Clinical Rounds)

Jane Salodof MacNeil . Skin & Allergy News.  March 2007 v38 i3 p61(1).

Full Text: COPYRIGHT 2007 International Medical News Group

PARIS — Trichotillomania was highly responsive to olanzapine in a small, randomized, placebo-controlled trial that suggests repetitive hair-pulling may be closer to tics and Tourette’s syndrome than to other obsessive-compulsive disorders. Eleven of 13 patients (85%) on olanzapine (Zyprexa) improved during the 12-week trial reported by Dr. Michael Van Ameringen at the annual congress of the European College of Neuropsychopharmacology. Only 2 of 12 patients (17%) on placebo were able to stop pulling out their hair. Dr. Van Ameringen, codirector of the anxiety disorders clinic at McMaster University in Hamilton, Ont., said he and his colleagues began testing antipsychotics because treatments for obsessive-compulsive disorder have been largely ineffective in patients with trichotillomania. The investigators wondered, he said, whether the condition might be closer to tics and Tourette’s syndrome, disorders characterized by compulsive urges and ritualistic behavior that also do not respond to the selective serotonin reuptake inhibitors (SSRIs) used for obsessive-compulsive disorder. “We found a very robust effect in our study (85% vs. 17%)…. It would be one of the biggest drug-placebo differences in psychiatry if it holds up in larger trials,” Dr. Van Ameringen said in an interview at the meeting. The investigators had previously studied haloperidol (Haldol) with good results in this population though not in a placebo-controlled trial, he said. They also have had positive clinical experiences with risperidone (Risperdal) and quetiapine (Seroquel), he added. Dr. Van Ameringen said he would like to see a large, randomized controlled trial with one of the new atypical antipsychotics if he could find funding. Eli Lilly Canada provided medication for the olanzapine trial. The 25 participants ranged in age from 18 to 35 years, with a mean age of 33 years and an average duration of illness of 21 years. The mean age of onset of trichotillomania was 12 years. Seventeen patients were female. Nearly two-thirds of the patients had no previous treatment for trichotillomania, despite a Clinical Global Impression-Severity (CGI-S) score of 4 or more at baseline. The scalp was the most common hair-pulling site. Next were the eyebrows and eyelashes. Patients randomized to olanzapine started on 2.5 rag/day for the first 3 weeks. The dose could be titrated up to 20 mg/day for the last 4 weeks. It was titrated down for 1 week before being stopped after completion of the study. The average dose at the end point was 10.8 mg/day of olanzapine and 19.2 mg/day of placebo. Investigators used several outcome measures, including photographs, the Structured Clinical Interview for DSM-IV, and the Minnesota Trichotillomania Assessment Inventory. The CGI-Improvement scale was the primary efficacy measure. All but two patients finished the trial; both dropouts were in the placebo group at week 10. Dr. Van Ameringen reported the average time to treatment response was 8.2 weeks with olanzapine and 10 weeks with placebo. The investigators calculated the effect size as 1.34 on the CGI-S scale and 1.01 on the Yale-Brown Obsessive-Compulsive Severity Scale for trichotillomania. All patients but four (who were in the placebo group) experienced side effects during the trial, Dr. Van Ameringen said. Dry mouth and fatigue were the most common adverse events reported with olanzapine, each occurring in 54% of patients. Other common side effects were increased appetite (46%), headache (39%), and weight gain (39%). Trichotillomania patients can tolerate the side effects, Dr. Van Ameringen said. “When they start gaining weight, then we switch to a different atypical.” BY JANE SALODOF MACNEIL