Healthy Skepticism Library item: 12040
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Publication type: Journal Article
Stroup TS, Lieberman JA, McEvoy JP, Swartz MS, Davis SM, Rosenheck RA, Perkins DO, Keefe RS, Davis CE, Severe J, Hsiao JK; CATIE Investigators.
Effectiveness of olanzapine, quetiapine, risperidone, and ziprasidone in patients with chronic schizophrenia following discontinuation of a previous atypical antipsychotic.
Am J Psychiatry 2006 Apr; 163:(4):611-22
http://ajp.psychiatryonline.org/cgi/content/full/163/4/611
Abstract:
BACKGROUND: In the treatment of schizophrenia, changing antipsychotics is common when one treatment is suboptimally effective, but the relative effectiveness of drugs used in this strategy is unknown. This randomized, double-blind study compared olanzapine, quetiapine, risperidone, and ziprasidone in patients who had just discontinued a different atypical antipsychotic.
METHOD: Subjects with schizophrenia (N=444) who had discontinued the atypical antipsychotic randomly assigned during phase 1 of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) investigation were randomly reassigned to double-blind treatment with a different antipsychotic (olanzapine, 7.5-30 mg/day [N=66]; quetiapine, 200-800 mg/day [N=63]; risperidone, 1.5-6.0 mg/day [N=69]; or ziprasidone, 40-160 mg/day [N=135]). The primary aim was to determine if there were differences between these four treatments in effectiveness measured by time until discontinuation for any reason.
RESULTS: The time to treatment discontinuation was longer for patients treated with risperidone (median: 7.0 months) and olanzapine (6.3 months) than with quetiapine (4.0 months) and ziprasidone (2.8 months). Among patients who discontinued their previous antipsychotic because of inefficacy (N=184), olanzapine was more effective than quetiapine and ziprasidone, and risperidone was more effective than quetiapine. There were no significant differences between antipsychotics among those who discontinued their previous treatment because of intolerability (N=168).
CONCLUSIONS: Among this group of patients with chronic schizophrenia who had just discontinued treatment with an atypical antipsychotic, risperidone and olanzapine were more effective than quetiapine and ziprasidone as reflected by longer time until discontinuation for any reason.
Keywords:
Publication Types:
Comparative Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
MeSH Terms:
Adult
Antipsychotic Agents/adverse effects
Antipsychotic Agents/therapeutic use*
Benzodiazepines/therapeutic use
Body Weight/drug effects
Chronic Disease
Cross-Over Studies
Dibenzothiazepines/therapeutic use
Double-Blind Method
Drug Administration Schedule
Female
Humans
Male
Patient Dropouts
Piperazines/therapeutic use
Proportional Hazards Models
Risperidone/therapeutic use
Schizophrenia/drug therapy*
Schizophrenic Psychology
Survival Analysis
Thiazoles/therapeutic use
Time Factors
Treatment Outcome
Substances:
Antipsychotic Agents
Benzodiazepines
Dibenzothiazepines
Piperazines
Thiazoles
quetiapine
Risperidone
olanzapine
ziprasidone
Notes:
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