We sought to understand how findings of the Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS band 1)1 and their comparison with those from phase 1 of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study in schizophrenia2,3 clarify issues raised in our 2005 American Psychiatric Association annual meeting debate “Second-Generation Antipsychotics (SGAs) Are Uniformly Superior in Efficacy and Safety to First-Generation Antipsychotics (FGAs).”4 Applying the primary effectiveness metric used in CATIE to CUtLASS band 1 findings, we noted that in contrast to 60 of 118 patients (51%) assigned to receive an FGA who continually took an FGA through the 1-year study, 70 of 109 patients (64%) assigned to receive an SGA did so (χ21 = 4.14; P < .05). In CUtLASS band 1, SGAs were found to be more effective than FGAs in terms of all-cause discontinuation. Despite this apparent SGA advantage in a nonblinded aspect of that study, results of both CATIE and CUtLASS band 1 indicate that FGAs are as effective as SGAs. How does one reconcile this observation with previous findings suggesting that SGAs are more effective than FGAs?
Tandon R, Carpenter WT, Davis JM. First- and Second-Generation Antipsychotics: Learning From CUtLASS and CATIE. Arch Gen Psychiatry. 2007;64(8):977-978. doi:10.1001/archpsyc.64.8.977