CAFE trial data indicate that several atypical antipsychotic agents are equally effective against the first episode of psychosis
Data from the CAFE (Comparison of Atypicals
in First Episode Psychosis) trial indicate that quetiapine, olanzapine,
and risperidone are equally effective in patients experiencing their
first episode of psychosis, according to a presentation at the European
College of Neuropsychopharmacology Congress.
The CAFE trial was the first to examine the
comparative effectiveness of quetiapine, olanzapine, and risperidone
in patients with a first episode of psychosis as measured by all-cause
treatment discontinuation. At week 52, all-cause treatment discontinuation
rates were similar between medications (70.9 percent, 68.4 percent
and 71.4 percent for quetiapine, olanzapine and risperidone, respectively).
However, significantly more olanzapine patients
(80 percent) experienced weight gain of seven percent or more relative
to baseline, compared with 57.6 percent for risperidone and 50 percent
for quetiapine.
Commenting on the data, Professor Henry Nasrallah,
Professor of Psychiatry, Neurology, & Neuroscience at the University
of Cincinnati Medical Center, USA, said that the CAFE study shows
the three atypicals had similar rates of discontinuation and similar
secondary efficacy outcomes.
The mean-mode average daily doses in CAFE
were 506 mg for quetiapine, 11.7 mg for olanzapine, and 2.4 mg for
risperidone. However, Nasrallah said it was important to remember
that in chronic schizophrenia, patients generally need higher doses
of medication and clinicians should explore the full dose ranges
of medications.
"The study reinforces the need for a
variety of medications so that clinicians can find the best treatment
option, with optimal risk benefit ratio, for each patient. It also
highlights how important patient-physician communication is in maximizing
treatment success," said Nasrallah.
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