CATIE confirms Zyprexa is more effective on discontinuation rate than other antipsychotics studied

Independent head-to-head study shows patients taking Zyprexa had longer duration of successful treatment and lower hospitalisation rates.

Zyprexa (olanzapine) was more effective on discontinuation rate in patients with schizophrenia than other medications studied, according to the conclusions of the Clinical Antipsychotic Trial of Intervention Effectiveness (CATIE). This unprecedented study was conducted by the National Institute of Mental Health in the United States and involved more than 1,400 people in a variety of treatment settings. It is the largest, longest and most comprehensive independent trial comparing therapies for schizophrenia. The study will appear in New England Journal of Medicine on September 22. CATIE was designed to evaluate the overall clinical effectiveness of antipsychotics in the treatment of schizophrenia, as measured by any-cause medication discontinuation, a measure that integrates both the patients’ and the doctors’ judgment of how well a medication works, its safety and how well the patient tolerates the treatment. “We are pleased that CATIE showed Zyprexa to be more effective on discontinuation rate than other medications studied,” said Gordon Hirsch, medical director, Eli Lilly Australia. “The study also had favourable findings for Zyprexa in terms of duration of successful treatment and risks of rehospitalisation.” “This is important to patients and doctors because research shows that patients who stay on their medication generally have greater improvement in symptoms, reducing hospitalisation and costs, and may function better in their daily lives,” he said. CATIE found that for Zyprexa the average time to discontinuation was 9.2 months, compared with 4.6 months for quetiapine, 4.8 months for risperidone, 3.5 months for ziprasidone and 5.6 months for perphenazine. The differences were statistically significant for olanzapine compared with risperidone and quetiapine, but not for perphenazine or ziprasidone. Patients taking Zyprexa also experienced fewer hospitalisations for schizophrenia than patients taking other medications. Another study showed that hospitalisation accounts for 72 per cent – the largest expense – of total health costs for Australians with schizophrenia. Total PANSS (Positive and Negative Syndrome Scale) scores improved over time in all groups, and patients taking Zyprexa had greater initial improvement. “The CATIE study is important because it directly compares the main drug treatment options for schizophrenia in a large population in a naturalistic setting,” said Professor Patrick McGorry, Department of Psychiatry at the University of Melbourne and director of the Early Psychosis Prevention and Intervention Centre. “The United States is, however, a very different setting in terms of continuity of, and access to care, and that needs to be borne in mind when the high rates of discontinuation in this study are considered.” “While the study shows relatively modest advantages of new agents, there are other variables, such as quality of life and functional outcomes, not reported in CATIE that significantly differentiate agents in ways we as clinicians know are highly valued by consumers,” he said. “Schizophrenia is a complex disorder. Even in the group with the lowest discontinuation rate – patients on Zyprexa – more than half discontinued treatment within 18 months. This is why we continue to invest in researching new treatments as well as programs to help patients benefit more fully from treatments available today,” said Hirsch. “We believe this study can help clinicians renew their focus on finding the treatment that will achieve the best possible results for each patient with schizophrenia.” The study authors also noted that patients taking Zyprexa experienced greater weight gain and increases in measures of glucose and lipid metabolism versus patients using other antipsychotics that were studied, which also had some associated weight gain. Information about adverse events related to increases in blood glucose levels, lipid metabolism and weight gain is included in the Zyprexa product label. For patients who discontinued treatment due to adverse events, more patients taking Zyprexa discontinued because of weight gain and metabolic events.