Posted by SLS on January 7, 2007, at 6:57:14
In reply to atypicals, etc., posted by med_empowered on January 7, 2007, at 0:06:57
I'm surprised you haven't brought into the conversation the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study.
It supports your point of view.
I don't think it proves very much more than that perphenazine is a pretty good typical antipsychotic. I didn't like it when I took it, though. I felt numb and passified. I felt like a zombie. The same was true of Thorazine and Prolixin. I have not experienced such a thing with any of the atypicals, and I have taken them all with the exception of clozapine. Not only that, but the atypicals have been more effective in producing an antidepressant effect. Zyprexa was a potent antimanic and produced great clarity of thought.
n=1
Paper versus real life.
I don't know what to make of the CATIE study. It has been scrutinized and debated, of course. If you search on Google, you will find critiques of it. I really don't think much of the design, and I think the study was to ambitious, but I'll let Google worry about that.
---------------------------------------------Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia
Jeffrey A. Lieberman, M.D., T. Scott Stroup, M.D., M.P.H., Joseph P. McEvoy, M.D., Marvin S. Swartz, M.D., Robert A. Rosenheck, M.D., Diana O. Perkins, M.D., M.P.H., Richard S.E. Keefe, Ph.D., Sonia M. Davis, Dr.P.H., Clarence E. Davis, Ph.D., Barry D. Lebowitz, Ph.D., Joanne Severe, M.S., John K. Hsiao, M.D.,
for the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Investigators
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.
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- Scott
poster:SLS
thread:719688
URL: http://www.dr-bob.org/babble/20070107/msgs/720096.html