• DOI:10.1056/NEJMOA051688
• Corpus ID: 22499842

Effectiveness of antipsychotic drugs in patients with chronic schizophrenia.

@article{Lieberman2005EffectivenessOA,
  title={Effectiveness of antipsychotic drugs in patients with chronic schizophrenia.},
  author={Jeffrey A. Lieberman and T. Scott Stroup and Joseph P. McEvoy and Marvin S. Swartz and Robert A. Rosenheck and Diana O. Perkins and Richard S. E. Keefe and Sonia M. Davis and Clarence E. Davis and Barry Lebowitz and Joanne B. Severe and John K. Hsiao},
  journal={The New England journal of medicine},
  year={2005},
  volume={353 12},
  pages={
          1209-23
        }
}

• J. Lieberman, T. Stroup, +9 authors J. Hsiao
• Published 22 September 2005
• Psychology, Medicine
• The New England journal of medicine

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.