Mid-term and long-term efficacy and effectiveness of antipsychotic medications
for schizophrenia: a data-driven, personalized clinical approach.
Author(s): Glick ID, Correll CU, Altamura AC, Marder SR, Csernansky JG, Weiden PJ, Leucht S,
Davis JM.
Affiliation(s): Department of Psychiatry and Behavioral Sciences, Stanford University School of
Medicine, Stanford, California, USA. iraglick@stanford.edu
Publication date & source: 2011, J Clin Psychiatry. , 72(12):1616-27
OBJECTIVE: Our aim in this article is 2-fold: first, to examine the mid-term to
long-term data on efficacy, from controlled and naturalistic and other studies,
in order to determine if they are consistent with the quantitative meta-analyses
of mostly short-term, randomized controlled trials Our second (and most
important) aim is to use these and other data to provide guidance about the
potential relationship of these differences among antipsychotics to the
individual patient's own experience with antipsychotic drugs in the process of
shared decision-making with the patients and their significant others.
DATA SOURCES: A search of PubMed, Embase, and PsychINFO was conducted for
articles published in English between January 1, 1999, and April 2011, using the
search terms double-blind AND randomized AND olanzapine AND (ziprasidone OR
risperidone OR quetiapine OR haloperidol OR fluphenazine OR perphenazine OR
aripiprazole).
STUDY SELECTION: Studies with a duration 3 months or longer, including patients
with schizophrenia or schizoaffective disorder, reporting survival analysis for
all-cause discontinuation and relapse or dropout due to poor efficacy were
selected.
DATA EXTRACTION: We extracted the number of patients relapsed due to poor
efficacy and hazard rates for relapses.
DATA SYNTHESIS: Overall, the efficacy patterns of both controlled effectiveness
and observational long-term studies closely parallel the efficacy observed in the
short-term, controlled studies. The results of Phase 1 Clinical Antipsychotic
Trials of Intervention Effectiveness are very similar to, but not identical with,
the controlled short-term efficacy studies, the European First-Episode
Schizophrenia Trial, and naturalistic studies. The mid-term and long-term data
suggest that olanzapine is more effective than risperidone and that both of these
are better than the other first- and second-generation antipsychotics except for
clozapine, which is the most efficacious of all. Further large differences
emerged regarding the specific mid-term and long-term safety profiles of
individual antipsychotics.
CONCLUSIONS: Despite intraclass differences and the complexities of antipsychotic
choice, the second-generation antipsychotics are important contributions not only
to the acute phase but, more importantly, to the maintenance treatment of
schizophrenia.
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