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"Effectiveness of antipsychotic drugs
in patients with chronic schizophrenia,"
by J.A. Lieberman and 11 others (the CATIE Investigators), New England
Journal of Medicine, 353(12): 1209-23, 22 September 2005.
[Authors' affiliations: Columbia University,
New York, NY; University of North Carolina, Chapel Hill; John Umstead
Hospital, Butner, NC; Duke University Medical Center, Durham, NC; Yale
University, New Haven, CT; NIMH, Bethesda, MD]
Abstract:
"BACKGROUND The relative effectiveness of second-generation
(atypical) antipsychotic drugs as compared with that of older agents has been
incompletely addressed, though newer agents are currently used far more
commonly. We compared a first-generation antipsychotic, perphenazine, with
several newer drugs in a double-blind study. METHODS A total of 1493
patients with schizophrenia were recruited at 57 U.S. sites and randomly
assigned to receive olanzapine (7.5 to 30 mg per day), perphenazine (8 to 32
mg per day), quetiapine (200 to 800 mg per day), or risperidone (1.5 to 6.0 mg
per day) for up to 18 months. Ziprasidone (40 to 160 mg per day) was included
after its approval by the Food and Drug Administration. The primary aim was to
delineate differences in the overall effectiveness of these five treatments. RESULTS
Overall, 74 percent of patients discontinued the study medication before 18
months (1061 of the 1432 patients who received at least one dose): 64 percent
of those assigned to olanzapine, 75 percent of those assigned to perphenazine,
82 percent of those assigned to quetiapine, 74 percent of those assigned to
risperidone, and 79 percent of those assigned to ziprasidone. The time to the
discontinuation of treatment for any cause was significantly longer in the
olanzapine group than in the quetiapine (P<0.001) or risperidone (P=0.002)
group, but not in the perphenazine (P=0.021) or ziprasidone (P=0.028) group.
The times to discontinuation because of intolerable side effects were similar
among
the groups, but the rates differed (P=0.04); olanzapine was associated with
more discontinuation for weight gain or metabolic effects, and perphenazine
was associated with more discontinuation for extrapyramidal effects.
CONCLUSIONS The majority of patients in each group discontinued their
assigned treatment owing to inefficacy or intolerable side effects or for
other reasons. Olanzapine was the most effective in terms of the rates of
discontinuation, and the efficacy of the conventional antipsychotic agent
perphenazine appeared similar to that of quetiapine, risperidone, and
ziprasidone. Olanzapine was associated with greater weight gain and increases
in measures of glucose and lipid metabolism."
This 2005 report from the New England
Journal of Medicine was cited 50 times in current journal
articles
indexed by Thomson Scientific during September-October 2006. Only one other
medicine paper published in
the last two years (aside from reviews) garnered a greater number of citations
during that two-month period. Prior
to the most recent bimonthly count, citations to the paper have accrued as
follows:
July-August 2006: 32 citations
May-June 2006: 30
March-April 2006: 24
January-February 2006: 15
November-December 2005: 4
September-October 2005: 3
Total citations to date: 158
SOURCE: Hot
Papers Database (Included with a subscription to the print newsletter Science
Watch®, available from the
Research Services Group. Packaged on a CD that is mailed with each Science
Watch issue, the Hot
Papers Database contains data on hundreds of highly cited papers published
during the last two years. User interface permits searching by author,
organization, journal, field, and more. Total citations, as well as citations
accrued during successive bimonthly periods, can be assessed and graphed. An
updated CD containing the most recent bimonthly data is mailed with every new
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