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Letters to the Editor
August 2007

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

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?