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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