Are certain antipsychotic drugs more effective in managing the symptoms of schizophrenia?

Updated: Mar 16, 2018
  • Author: Frances R Frankenburg, MD; Chief Editor: Glen L Xiong, MD  more...
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For some years, it was believed that the newer antipsychotic drugs were more effective, but there is now some uncertainty about that. An exception is clozapine, which consistently outperforms the other antipsychotic drugs.

Phase 1 of the CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness) study, a large nationwide trial that compared the first-generation antipsychotic perphenazine with the second-generation drugs olanzapine, risperidone, quetiapine, and ziprasidone, found that olanzapine was slightly better than the other drugs in terms of the patients choosing to stay on it, and number of hospitalizations, but also was associated with significant weight gain. Surprisingly, perphenazine performed about as well as the other 3 second-generation agents. [83]

In this and other studies the primary outcome, stopping the drug, may seem to be unusual. It is used because it reflects the “real-world” decision of the clinician and patient that the agent is either no longer tolerable or effective.

In CUtLASS (Cost Utility of the Latest Antipsychotic drugs in Schizophrenia Study), a study from the United Kingdom, more than 200 patients who were about to change antipsychotic medication were randomly assigned to either a first-generation or a second-generation agent. In this study, the first-generation drugs seemed to perform slightly better than the newer ones, as measured by the Quality-of-Life Scale. [84]

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