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Schizophrenia Drug Face-Off: No Clear Winner

Surprise Finding: Older Antipsychotics Can Be as Good as New Ones

'Traditional' Drug vs. Newer 'Atypical' Drugs continued...

A sixth atypical antipsychotic drug, Abilify, wasn't included because the FDA had not approved it by the time of the trial.

What happened in phase 1 of the CATIE trial?

"Zyprexa was somewhat better in efficacy but had the most side effects," Lieberman said. "The biggest surprise was that the oldest medication [Trilafon] was comparable to at least three of the new medications and not much worse than Zyprexa. Contrary to expectations, the old drug did not cause more Parkinson's symptoms than the new drugs."

Some scientists involved in designing the study hadn't even thought the old drugs were worth including in the trial, says study investigator Robert Rosenheck, MD, of Yale University.

"Many of us thought the question was decided and the old drugs were of no value," Rosenheck said at the news conference. "Because we were willing to ask a question that most people thought they knew the answer to, we were able to get a surprising answer."

Doctors Get New Insight

The study findings aren't what everyone hoped for, notes University of Colorado researcher Robert Freedman, MD, in an editorial accompanying the CATIE report.

"The results could be viewed as discouraging," Freedman writes. "No drug provided the majority of patients a treatment that lasted the full 18 months of the study. ... Only 36% of the patients receiving the most effective drug, [Zyprexa], completed the trial."

But Rosenheck tells WebMD that patients who are happy with their schizophrenia medication don't enter clinical trials.

"We psychiatrists all know patients who have been on the same treatment for many years, even for decades," he says. "Those entering a trial are interested in switching. This is not representative of all patients, many of whom are quite stable -- just those interested in trying something new."

And many patients are hoping for something new.

"Only the minority of patients are unresponsive and cannot benefit from antipsychotic medications," Lieberman tells WebMD. "The switching you see is because the level of response they get from a medication is, for many people, less than what they, their doctors, their families, and their significant others would like to see."

Study investigator T. Scott Stroup, MD, MPH, of the University of North Carolina at Chapel Hill, tells WebMD that when treatment is carefully matched to an individual patient's needs, most patients find something that works.

Lieberman says that's the lasting value of the CATIE study. It gives doctors information -- a lot more information than was ever before available -- on how to match treatment effects and side effects to the needs of an individual suffering from schizophrenia.

Stay tuned. The coming months and years will see more reports as researchers analyze data from the various phases of the CATIE trial.

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