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First- vs Second-Generation Antipsychotic Drugs in Schizophrenia
Chittaranjan Andrade, MD;
Saifuddin Kharawala, DPM
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The Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS 1)1 found that, in patients with schizophrenia whose medication was changed for clinical reasons, first (FGA)- and second (SGA)-generation antipsychotics were associated with comparable 1-year outcomes on measures of clinical improvement, adverse effects, quality of life, and costs of care. We have several concerns about the study:
- During the study, 55 of 118 patients (47%) switched from an FGA to an SGA, but only 36 of 109 (33%) switched from an SGA to an FGA (Figure 11[p1081]); the advantage for the SGA was statistically significant (
 21 = 4.35; P < .05). The most commonly prescribed FGA and SGA were sulpiride and olanzapine, respectively; the 1-year persistence rates for these drugs were 28 of 58 (48%) and 37 of 50 (74%), respectively. The advantage for olanzapine was statistically significant (21 = 7.42; P < .001). Neither . . . [Full Text of this Article]
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First- vs Second-Generation Antipsychotic Drugs in Schizophrenia—Reply
Peter B. Jones, Thomas R. E. Barnes, Peter Elton, Linda Davies, Graham Dunn, Helen Lloyd, Karen P. Hayhurst, Robin M. Murray, Alison Marwick, and Shôn Lewis
Arch Gen Psychiatry. 2007;64(8):979-980.
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Randomized Controlled Trial of the Effect on Quality of Life of Second- vs First-Generation Antipsychotic Drugs in Schizophrenia: Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS 1)
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Arch Gen Psychiatry. 2006;63(10):1079-1087.
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