Citrome Leslie
Dr. Citrome is from the New York University School of Medicine, Department of Psychiatry, and the Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York.
Psychiatry (Edgmont). 2007 Oct;4(10):23-9.
The NIMH-funded Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) for schizophrenia enrolled close to 1500 patients and is the largest randomized clinical trial to date that compares several of the second-generation antipsychotics on overall effectiveness. This article reviews the use of the evidence-based medicine tool "number needed to treat" to interpret what the CATIE results mean when choosing among the different antipsychotics available. Depending on the phase of CATIE, different antipsychotics had different rankings for overall effectiveness. CATIE can be viewed as a switch study, and depending on the circumstances or reason for the switch and the medication the patient was switched from, different outcomes were seen for the antipsychotics tested. Olanzapine had advantages in terms of all-cause discontinuation and efficacy, particularly in Phase 1. Quetiapine (and olanzapine) had advantages in terms of all-cause discontinuation in Phase 1B where patients had failed perphenazine. Clozapine was superior to risperidone and quetiapine for patients who discontinued a second-generation antipsychotic in Phase 1 (or 1B) because of poor efficacy. Risperidone had advantages in terms of overall tolerability in Phase 1, 2E, and 2T. Ziprasidone had the most benign metabolic profile, and in phase 2T was associated with a higher likelihood of weight loss for patients who gained greater than seven percent of their initial body weight in Phase 1. Treating clinicians need access to all of these medications in order to optimize treatment for the individual patient.
由美国国立精神卫生研究所（NIMH）资助的精神分裂症临床抗精神病药物干预有效性试验（CATIE）招募了近1500名患者，是迄今为止比较几种第二代抗精神病药物总体有效性的最大规模随机临床试验。本文回顾了循证医学工具“需治疗人数”的应用，以解读在不同可用抗精神病药物中进行选择时CATIE结果的意义。根据CATIE的不同阶段，不同抗精神病药物在总体有效性方面有不同排名。CATIE可被视为一项换药研究，根据换药的情况或原因以及患者换药前所使用的药物，所测试的抗精神病药物会出现不同结果。奥氮平在全因停药率和疗效方面具有优势，尤其是在第一阶段。在第一阶段B中，对于使用奋乃静治疗失败的患者，喹硫平（和奥氮平）在全因停药率方面具有优势。对于在第一阶段（或第一阶段B）因疗效不佳而停用第二代抗精神病药物的患者，氯氮平优于利培酮和喹硫平。利培酮在第一阶段、2E阶段和2T阶段的总体耐受性方面具有优势。齐拉西酮具有最良性的代谢特征，在2T阶段，对于在第一阶段体重增加超过初始体重7%的患者，其体重减轻的可能性更高。临床治疗医生需要能够使用所有这些药物，以便为个体患者优化治疗。
