Effectiveness of antipsychotic drugs in patients with chronic schizophrenia

Jeffrey A. Lieberman, T. Scott Stroup, Joseph Patrick McEvoy, Marvin S. Swartz, Robert A. Rosenheck, Diana O. Perkins, Richard S.E. Keefe, Sonia M. Davis, Clarence E. Davis, Barry D. Lebowitz, Joanne Severe, John K. Hsiao

Research output: Contribution to journalArticle

4248 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1209-1223
Number of pages15
JournalNew England Journal of Medicine
Volume353
Issue number12
DOIs
StatePublished - Sep 22 2005

Fingerprint

olanzapine
Perphenazine
Antipsychotic Agents
Schizophrenia
Risperidone
Weight Gain
United States Food and Drug Administration
Lipid Metabolism
Double-Blind Method
Glucose

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Lieberman, J. A., Scott Stroup, T., McEvoy, J. P., Swartz, M. S., Rosenheck, R. A., Perkins, D. O., ... Hsiao, J. K. (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine, 353(12), 1209-1223. https://doi.org/10.1056/NEJMoa051688

Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. / Lieberman, Jeffrey A.; Scott Stroup, T.; McEvoy, Joseph Patrick; Swartz, Marvin S.; Rosenheck, Robert A.; Perkins, Diana O.; Keefe, Richard S.E.; Davis, Sonia M.; Davis, Clarence E.; Lebowitz, Barry D.; Severe, Joanne; Hsiao, John K.

In: New England Journal of Medicine, Vol. 353, No. 12, 22.09.2005, p. 1209-1223.

Research output: Contribution to journalArticle

Lieberman, JA, Scott Stroup, T, McEvoy, JP, Swartz, MS, Rosenheck, RA, Perkins, DO, Keefe, RSE, Davis, SM, Davis, CE, Lebowitz, BD, Severe, J & Hsiao, JK 2005, 'Effectiveness of antipsychotic drugs in patients with chronic schizophrenia', New England Journal of Medicine, vol. 353, no. 12, pp. 1209-1223. https://doi.org/10.1056/NEJMoa051688
Lieberman JA, Scott Stroup T, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine. 2005 Sep 22;353(12):1209-1223. https://doi.org/10.1056/NEJMoa051688
Lieberman, Jeffrey A. ; Scott Stroup, T. ; McEvoy, Joseph Patrick ; Swartz, Marvin S. ; Rosenheck, Robert A. ; Perkins, Diana O. ; Keefe, Richard S.E. ; Davis, Sonia M. ; Davis, Clarence E. ; Lebowitz, Barry D. ; Severe, Joanne ; Hsiao, John K. / Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. In: New England Journal of Medicine. 2005 ; Vol. 353, No. 12. pp. 1209-1223.
@article{63f1ad5070b040da986e536315af893a,
title = "Effectiveness of antipsychotic drugs in patients with chronic schizophrenia",
abstract = "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.",
author = "Lieberman, {Jeffrey A.} and {Scott Stroup}, T. and McEvoy, {Joseph Patrick} and Swartz, {Marvin S.} and Rosenheck, {Robert A.} and Perkins, {Diana O.} and Keefe, {Richard S.E.} and Davis, {Sonia M.} and Davis, {Clarence E.} and Lebowitz, {Barry D.} and Joanne Severe and Hsiao, {John K.}",
year = "2005",
month = "9",
day = "22",
doi = "10.1056/NEJMoa051688",
language = "English (US)",
volume = "353",
pages = "1209--1223",
journal = "New England Journal of Medicine",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "12",

}

TY - JOUR

T1 - Effectiveness of antipsychotic drugs in patients with chronic schizophrenia

AU - Lieberman, Jeffrey A.

AU - Scott Stroup, T.

AU - McEvoy, Joseph Patrick

AU - Swartz, Marvin S.

AU - Rosenheck, Robert A.

AU - Perkins, Diana O.

AU - Keefe, Richard S.E.

AU - Davis, Sonia M.

AU - Davis, Clarence E.

AU - Lebowitz, Barry D.

AU - Severe, Joanne

AU - Hsiao, John K.

PY - 2005/9/22

Y1 - 2005/9/22

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=25144456112&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=25144456112&partnerID=8YFLogxK

U2 - 10.1056/NEJMoa051688

DO - 10.1056/NEJMoa051688

M3 - Article

VL - 353

SP - 1209

EP - 1223

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 12

ER -