April 12, 2006

The Significance of CATIE: An Expert Interview With Jeffrey A. Lieberman, MD

Medscape has a recent interview with the leader of the recent CATIE research study - following is an excerpt.

Can you describe the rationale for the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE)?

Jeffrey A. Lieberman, MD: The reason for doing the CATIE study was that, since the introduction of clozapine in 1990, a series of newer, second-generation antipsychotic drugs have been approved by the US Food and Drug Administration and increasingly used by clinicians. The treatments have been embraced on the assumption that they are better and safer. As a result of their increasing use, total treatment costs have risen substantially to about $10 Billion in the United States and over $14 billion worldwide in 2005. Although this price may have been required for progress, it wasn't clear whether the preferential use and cost of the new medications were actually justified. At the time the study was conceived, circa 1998, it had not been clearly established that the second-generation drugs were truly superior to the first-generation drugs and that they were cost-effective. So the CATIE initiative was undertaken to answer 3 simple questions:

Are the second-generation antipsychotic agents better than the first-generation medications?

How do the second-generation drugs compare with each other? (There are now at least 5 of them, and few comparative studies have been conducted.)

Are the second-generation agents cost-effective?

Read the entire interview (Medscape, Free registration required)


CATTIE trial is just another study to undermine the efficacy of CLOZAPINE.None of the atypicals come anywhere near the efficay of clozapine but the bogey of Bloodcount drop is always flaunted.I have asked many psychodocs about the bloodcount drop which necessiated a discontinuance of clozapine.Many never faced this situation.By prescribing respirodone,olanzapine etc; actually the psychodocs are actually making a case chronic.If clozapine in low dosage is given in first instance; i think many a patients will not reach the chronic stage at all.

Posted by: captainjohann at April 13, 2006 06:17 AM

there isn't anything out there that proves that.

surely, some people would do better if they started on clozaril instead of trying several drugs for several years that didn't wind up working well for them. but at this point, due to other reasons, clozaril is not the first drug people are given, and the technology to fully determine which drug a person should start on is in part not yet availale, and in part not yet cheap enough to be used generally.

clozaril is indeed a fantastic drug and very likely works on quite different targets than the above mentioned medications.

but the fact is that many people take the above mentioned medications and manage their illness very effectively. the data isn't in that would suggest that the entire population of schizophrenics all get into difficulty from not being maintained on clozaril.

but at the same time, the statistics on 'doing well with clozaril' are in part so glowing because of who gets the medication, how it is delivered in the health care system, and how freqently they see their doctor and how much supervision they get.

Posted by: slc at May 4, 2006 09:35 AM

the other trouble of course is, 'define what you mean by chronic stage'.

schizophrenia is a chronic disease, and has to be managed as a persistent illness. not even clozaril is going to make it go away. even it has 'maintenance target' rather than a 'cure target' and it has to continue to be taken as well.

Posted by: slc at May 4, 2006 09:36 AM

Dear Slc,
I should have used the word "maintenace Stage".You have very rightly pointed out that there is no SCIENTIFIC BASIS in PSYCHIATRY for prescribing a particular drug for a particular person.That is the main reason for me to say that CLOZARIL should be the drug of choice in the first instance itself.The danger of AGRANULOCYTOSIS and the need for periodic blood testing is unnessarily exaggerated thereby making clozapine an expensive drug to use.The need for testing after the first 3months is almost 3 months gap ;while need for testing after one year of use becomes almost NIL>.But the need for testing which occurs in 1% of patients is purposely exaggerated by drug MNCs so that they can sell the new ATYPICALS WHICH HAVE MORE SIDE EFFECTS!. Olanzapine is associated with disbetes and others are associted with TD etc while the gain with clozaril in negative symptoms and the peace which it gives to cares is immensely beneficial.But drug MNCs have manipulated WORLD HEALTH ORGANISATION(WHO) in Geneva not to include CLOZARIL in the WHO essential drug list of 354 drugs!!!!Any psychiatrist will say how essential clozapine is in treating Schizophrenia,Bipolar but not WHO!!!!!!Recently a boy who had severe OCD along with violence had miraculous relief from clozapine.
By the way in India the generic version of clozapine costs only 2 US cents per 100mg tablet!!!!!!!!!!!!!!!

Posted by: captainjohann at May 6, 2006 01:27 AM

can someone with paranoid schizophrenic give birth to a baby?

Posted by: Akins D. at May 8, 2006 02:59 PM

Post a comment

Please enter this code to enable your comment -
Remember Me?
(you may use HTML tags for style)
* indicates required