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Understanding the Results of CATIE in the Context of the Field

Published online by Cambridge University Press:  07 November 2014

Ira D. Glick
Ira D. Glick*
Affiliation:
Dr. Glick is professor in the Departments of Psychiatry and Behavioral Sciences, and Psychopharmacology at, Stanford University School of Medicine in California.
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Abstract

The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study was undertaken to provide a valid assessment of the differences between conventional and atypical antipsychotics and among the atypicals themselves in patients with schizophrenia. The CATIE investigators reported that while none of the study medications were ideal, olanzapine was the most effective in terms of treatment discontinuation, and there were no significant differences in effectiveness between the conventional antipsychotic perphenazine and the atypicals quetiapine, risperidone, and ziprasidone. Each drug differed slightly in rates of side effects, with more patients discontinuing perphenazine due to extrapyramidal side effects and more patients discontinuing olanzapine due to weight gain and metabolic effects. In order for data from phase 1 of the CATIE study to be interpreted within the appropriate context, physicians must understand how aspects of study design and statistical methods affect interpretation, and how this trial weighs against other data in the literature. This article enumerates the factors that complicate our understanding of the CATIE results and compares these findings with those from previously published meta-analyses. It is clear that therapeutic and side effects of antipsychotics vary from person to person. The goal of schizophrenia management is to maintain pharmacotherapeutic efficacy and tolerability over the long-term in order to maximize treatment adherence and benefits. What should emerge from CATIE is a renewed commitment to tailor schizophrenia treatment to the individual patient for long-term management.

Type
Research Article
Information
CNS Spectrums , Volume 11 , Issue S7 , 2006 , pp. 40 - 47
Copyright
Copyright © Cambridge University Press 2006

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References

1.Lieberman, JA, Stroup, TS, McEvoy, JP, et al, for the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Investigators. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005;353(12):1209–1223.CrossRefGoogle ScholarPubMed
2.Stroup, TS, McEvoy, JP, Swartz, MS, et al.The National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) project: schizophrenia design and protocol development. Schizophr Bull. 2003;29(1):15–31.CrossRefGoogle ScholarPubMed
3.Leucht, S, Barnes, TRE, Kissling, W, Engel, RR, Correll, C, Kane, JM. Relapse prevention in schizophrenia with new-generation antipsychotics: a systematic review and exploratory meta-analysis of randomized, controlled trials. Am J Psychiatry. 2003;160(7):1209–1222.CrossRefGoogle ScholarPubMed
4.Leucht, S, Wahlbeck, K, Hamann, J, Kissling, W. New generation antipsychotics versus low-potency conventional antipsychotics: a systematic review and meta-analysis. Lancet. 2003;361(9369):1581–1589.CrossRefGoogle ScholarPubMed
5.Davis, JM, Chen, N, Glick, ID. A meta-analysis of the efficacy of second-generation antipsychotics. Arch Gen Psychiatry. 2003;60(6):553–564.CrossRefGoogle ScholarPubMed
6.Wahlbeck, K, Tuunainen, A, Ahokas, A, Leucht, S. Dropout rates in randomized antipsychotic drug trials. Psychopharmacology. 2001;155(3):230–233.CrossRefGoogle ScholarPubMed
7.Geddes, J, Freemantle, N, Harrison, P, Bebbington, P, for the National Schizophrenia Guideleine Development Group. Atypical antipsychotics in the treatment of schizophrenia: systematic overview and meta-regression analysis. BMJ. 2000;321(7273):1371–1376CrossRefGoogle ScholarPubMed
8.Geddes, J. Generalizing evidence to inform policy and practice: the example of the second generation “atypical” antipsychotics. Schizophr Bull. 2003;29:105–114.CrossRefGoogle ScholarPubMed
9. IMS Health. Atypical antipsychotics: generating evidence to inform policy and practice. Available at: http://research.imshealth.com/research_schizophrenia.htm. Accessed: February 14, 2006.Google Scholar
10.Harrington, C, Gregorian, R, Gemmen, E, et al.Access and utilization of new antidepressant and antipsychotic medications. Falls Church, Va.: Lewin Group, 2000. Available at: http://aspe.hhs.gov/search/health/reports/Psychmedaccess/index.htm#TOC. Accessed: February 21, 2006.Google Scholar
11.Tunis, SR, Stryer, DB, Clancy, CM. Practical clinical trials: increasing the value of clinical research for decision making in clinical and health policy. JAMA. 2003;290(12):1624–1632.CrossRefGoogle ScholarPubMed
12.Swartz, MS, Perkins, DO, Stroup, TS, McEvoy, JP, Nieri, JM, Haak, DC. Assessing clinical and functional outcomes in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial. Schizophr Bull. 2003;29(1):33–43.CrossRefGoogle ScholarPubMed
13.Collins, EJ, Hogan, TP, Desai, H. Measurement of therapeutic response in schizophrenia. A critical survey. Schizophr Res. 1991;5(3):249–253.CrossRefGoogle ScholarPubMed
14.Cramer, JA, Rosenheck, R. Compliance with medication regimens for mental and physical disorders. Psychiatr Serv. 1998;49(2):196–201.CrossRefGoogle ScholarPubMed
15.Meltzer, HY. Interpreting the efficacy findings in CATIE: what clinicians should know. CNS Spectr. 2006;11(7 suppl 7):14–24.CrossRefGoogle ScholarPubMed
16.Kane, JM. Commentary on the clinical antipsychotic trials of intervention effectiveness (CATIE). J Clin Psychiatry. 2006; 67 (5):831–832.CrossRefGoogle ScholarPubMed
17.Weeks, M. NIMH study to guide treatment choices for schizophrenia [Medical News Today Web site]. September 20, 2005. Available at: http://www.medicalnewstoday.com/medicalnews.php?newsid=30861. Accessed: March 3, 2006Google Scholar
18.Stroup, TS, Lieberman, JA, McEvoy, JP, et al.Effectiveness of olanzapine, quetiapine, risperidone, and ziprasidone in patients with chronic schizophrenia following discontinuation of a previous atypical antipyschotic. Am J Psychiatry. 2006;163:611–622.CrossRefGoogle Scholar
19.McEvoy, JP, Lieberman, JA, Stroup, TS, et al.Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. Am J Psychiatry. 2006;163:600–610.CrossRefGoogle Scholar
20.Keefe, R, Bilder, RM, Harvey, PD, et al. Neurocognitive effects of antipsychotic medications in patient with chronic schizophrenia in the CATIE trial. Presented at: the 61st Annual Convention of the Society of Biological Psychiatry; May 18-20, 2006; Toronto, Canada. Abstract #311.Google Scholar
21.Davis, JM, Chen, N, Glick, ID. Web supplement: a meta-analysis of the efficacy of second-generation antipsychotics. Available at: http://www.psych.uic.edu/faculty/davis/meta_analysis.pdf. Accessed March 26, 2006.Google Scholar
22.Martin, JLR, Pérez, V, Sacristán, M, Rodríguez-Artalejo, F, Martínez, C, Álvarez, E.Meta-analysis of drop-out rates in randomized clinical trials, comparing typical and atypical antipsychotics in the treatment of schizophrenia. Eur Psychiatry. 2006;21(1):11–20.CrossRefGoogle ScholarPubMed
23.Fleischhacker, WW, Widschwendter, CG. Treatment of schizophrenia patients: comparing new generation antipsycotics to each other. Curr Opin Psychiatry. 2006;19(2):128–134.Google Scholar
24.Koyanagi, C, Forquer, S, Alfano, E. Medicaid policies to contain psychiatric drug costs. Health Aff. 2005; 24(2):536–544.CrossRefGoogle ScholarPubMed
25.Hamann, J, Langer, B, Leucht, S, Busch, R, Kissling, W. Medical decision making in antipsychotic drug choice for schizophrenia. Am J Psychiatry. 2004;161(7):1301–1304.CrossRefGoogle ScholarPubMed
26.Marder, SR, Essock, SM, Miller, AL, et al.Physical health monitoring of patients with schizophrenia. Am J Psychiatry. 2004;161(8):1334–1349.CrossRefGoogle ScholarPubMed
27.Goff, DC, Cather, C, Evins, AE, et al.Medical morbidity and mortality in schizophrenia: guidelines for psychiatrists. J Clin Psychiatry. 2005;66(2):183–194.CrossRefGoogle ScholarPubMed