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CATIE Phase II Released
April 5, 2006
Related Article: CATIE-AD
Press Release, October 2006
On April 1, 2006, the latest in a series of major research studies
funded by the National Institute of Mental Health (NIMH) into the
effectiveness of psychiatric medications was released.
Known as CATIE 2 (Clinical Antipsychotic Trials of Intervention
Effectiveness), the studies are part of the “Big Four”
clinical trials that include STAR*D (Sequenced Treatment Alternatives
to Relieve Depression), STEP-BD (Systematic Treatment Enhancement
Program) for bipolar disorder, and TADS (Treatment for Adolescent
Depression Study).
CATIE, STAR*D, STEP-BD and TADS are important because unlike clinical
trials conducted by private industry, their focus is longer and
comparative in nature, involving “real world” conditions.
They provide essential building blocks for a public research treatment
"infrastructure" that can lead to newer, better medications.
Results from the second phase of STAR*D were released on March
23, 2006, the week before this latest installment in the return
on public investment. Ironically, release of the studies comes at
a time when President Bush has proposed cutting NIMH’s budget
by $9 million. NAMI is fighting to restore the funds.
Medications Are Not Interchangeable
CATIE Phase 2 builds on an earlier study released last year, CATIE
Phase I, that did not find dramatic differences in medication adherence
when individuals were assigned randomly to either one old or several
new antipsychotic medications.
NAMI’s analysis of CATIE I was that it raised more questions
than answers. Later, NIMH also issued a clarification out of concern
that state Medicaid programs might misinterpret the CATIE I results
and lead them restrict formularies to cheaper, older drugs. “A
one-size-fits-all policy for treating schizophrenia could be harmful,
essentially turning the clock back 40 years when conventional antipsychotics
were the only medications available for patients,” NIMH declared.
(CATIE Phase 3 will address cost-effectiveness issues. NAMI will
provide information about Phase 3 when it is released).
CATIE Phase 2 provides additional information about choices in
the treatment of schizophrenia. Different individuals respond differently
to different drugs. If one medication is not fully effective in
treating schizophrenia, the study provides guidance to doctors about
switching to or adding a second drug.
CATIE II seeks to answer a basic and common clinical question –
what factors might inform decisions about further treatment when
a person does not respond to an initial antipsychotic medication?
For chronically ill individuals whose symptoms did not improve
on the first medication, clozapine produced substantial reductions
in symptoms and considerable improvements in medication adherence.
For those individuals who stopped their medication in Phase I because
they were experiencing psychotic symptoms, olanzapine and resperidone
produced better medication adherence and better symptom reduction
than ziprasidone or quetiapine.
For people who stopped taking medication during Phase I because
of side effects, no differences were noted between olanzapine, resperidone,
ziprasidone or quetiapine in reducing side effects.
These results once again demonstrate that antipsychotic medications
are not interchangeable. What works for one person may not work
for another.
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