What have we learned from CATIE about the pharmacologic treatment of schizophrenia?

The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study sponsored by the National Institute of Mental Health compared the effectiveness of four second-generation antipsychotics (olanzapine, risperidone, quetiapine, and ziprasidone), and one first-generation antipsychotic (perphenazine) in 1460 individuals with chronic schizophrenia. A hybrid of effectiveness and efficacy study design, the primary outcome was antipsychotic “effectiveness,” as measured by discontinuation of the assigned antipsychotic because of inadequate efficacy, inadequate tolerability, patient decision, or other reason. Most (64% to 82%) patients discontinued the phase-I antipsychotic before 18 months of treatment (approximately two-thirds subjects continued treatment with a different antipsychotic in phase 2). The five antipsychotics varied significantly in effectiveness, efficacy, and side-effect profiles. CATIE baseline results also find the general health of individuals with chronic schizophrenia to be poor, highlighting concerns about added risk from metabolic side effects of some antipsychotics. Analysis of comparative cost effectiveness, impact on cognition, rates of recovery, phase 2 results, and many other analyses are forthcoming, and the cumulative findings from the CATIE study will provide an evidence base for clinicians, health care administrators, patients and their families to make pharmacologic treatment choices.