Skip to content
Evevident
Original paper
2005NEJMPsychiatry

CATIE

Effectiveness of antipsychotic drugs in patients with chronic schizophrenia

RCTSchizophrenia

On this page

Overview

Most antipsychotics had high discontinuation rates; olanzapine lasted longer but caused more metabolic effects.

Clinical takeaway

CATIE challenged the assumption that atypical antipsychotics were uniformly superior, emphasizing effectiveness, tolerability, and patient-specific tradeoffs.

Key result

Treatment discontinuation was common across all groups; olanzapine had longer time to discontinuation but more weight/metabolic toxicity.

Practice impact

Antipsychotic choice became more explicitly individualized around benefit, adverse effects, and adherence.

Evidence

Study design

Large pragmatic randomized double-blind effectiveness trial.

Enrollment

1,493

Follow-up

Up to 18 months.

Geography

United States

Clinical question

How do commonly used antipsychotics compare in real-world effectiveness for chronic schizophrenia?

Population

  • Patients with chronic schizophrenia requiring antipsychotic treatment.

Intervention

Olanzapine, quetiapine, risperidone, ziprasidone, or perphenazine.

Comparator

Active antipsychotic comparators.

Primary outcome

Discontinuation of treatment for any cause.

Discontinuation was frequent with all antipsychotics; olanzapine performed best on persistence but worst on metabolic effects.

Median time to discontinuation

Key results

  • Overall discontinuation rates were high across all agents.
  • Olanzapine had the longest time to discontinuation.
  • Olanzapine caused more weight gain and adverse metabolic changes.

Harms

  • Olanzapine caused greater weight gain and metabolic abnormalities.
  • Perphenazine raised extrapyramidal-symptom concerns in clinical interpretation, though results were nuanced.

Clinical Use

When to cite

  • When comparing antipsychotic effectiveness and adverse-effect tradeoffs in schizophrenia.

Practice impact

  • Tempered blanket preference for second-generation antipsychotics and emphasized comparative effectiveness.

Applicability

  • Chronic schizophrenia patients where adherence, tolerability, and metabolic risk dominate medication choice.

Limitations

  • Discontinuation is pragmatic but influenced by clinician and patient preference.
  • Excluded some patients with tardive dyskinesia from perphenazine assignment.

Common misinterpretations

  • Do not summarize CATIE as 'first-generation equals second-generation' without discussing side-effect profiles and individual agents.

Citation

Lieberman JA, Stroup TS, McEvoy JP, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005;353(12):1209-1223. doi:10.1056/NEJMoa051688

The majority of patients in each group discontinued their assigned treatment owing to inefficacy or intolerable side effects or for other reasons.