Use of Long-Acting Risperidone

To the Editor: The lead article in the September 2004 issue by Dr. Keith and his colleagues styles itself as providing "practical advice" on the use of long-acting risperidone, based on a literature review and a panel discussion of international experts gathered in Dublin, Ireland, in spring 2003. As stated in the abstract, results, and acknowledgments, the entire effort was funded by an "educational grant" from Johnson & Johnson. Nowhere does it state that Janssen Pharmaceutica, the manufacturer of long-acting risperidone, is a member of the Johnson & Johnson "Family of Companies" (1), nor is the educational grant described as unrestricted. It is inherently misleading for such an article to masquerade as an academic review in a peer-reviewed journal, given its funding source.

As further evidence of the bias inherent in this article, one need look no further than the next article in the same issue of Psychiatric Services, wherein Dr. Citrome and his coauthors present their case-control study on the risk of diabetes with use of second-generation antipsychotics (2). These investigators determined that risperidone monotherapy had an elevated, though not statistically significant, risk of diabetes and that study participants who were taking two second-generation drugs (69 percent of whom were taking risperidone) showed a significant elevation in diabetes risk. Dr. Keith and colleagues recommend a cross-over strategy for initiating treatment with long-acting risperidone that would entail at least several weeks of treatment with more than one second-generation drug. Curiously, I could not find a single mention of diabetes in the Keith article. Nor, although it purports to be a review article, does the paper cite any of the several articles on diabetes risk with atypical antipsychotics that were cited in the Citrome article. Given the morbidity of diabetes, surely it would be "practical" and prudent to alert practitioners to this risk.

I must therefore question whether the article by Dr. Keith and his colleagues should have been published by Psychiatric Services. Given its provenance, it would have been better suited to one of the many journals that arrive, unbidden, in our mailboxes on a regular basis.