Aripiprazole, Ziprasidone and Quetiapine in the treatment of first-episode nonaffective psychosis: A 12-week randomized, flexible-dose, open-label trial

• Published in: Schizophrenia research Vol. 147; no. 2; pp. 375 - 382
• Main Authors: Crespo-Facorro, Benedicto, Ortiz-García de la Foz, Victor, Mata, Ignacio, Ayesa-Arriola, Rosa, Suarez-Pinilla, Paula, Valdizan, Elsa M, Vázquez-Barquero, José Luis, Pérez-Iglesias, Rocío
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 01.07.2013; Elsevier
• Subjects: Adult; Adult and adolescent clinical studies; Adverse effects; Analysis of Variance; Antipsychotic agents; Antipsychotic Agents - therapeutic use; Aripiprazole; Biological and medical sciences; Dibenzothiazepines - therapeutic use; Dose-Response Relationship, Drug; Female; Humans; Male; Medical sciences; Neuropharmacology; Outcome Assessment (Health Care); Pharmacology. Drug treatments; Piperazines - therapeutic use; Prospective Studies; Psychiatric Status Rating Scales; Psychiatry; Psycholeptics: tranquillizer, neuroleptic; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Psychoses; Psychotherapeutic processes; Psychotic Disorders - drug therapy; Quetiapine Fumarate; Quinolones - therapeutic use; Retrospective Studies; Schizophrenia; Thiazoles - therapeutic use; Time Factors; Young Adult; Schizophrenia; Antipsychotic agents; Adverse effects; Psychotherapeutic processes; Partial agonist; Atypical antipsychotic; Neuroleptic; Psychotropic; Quinolinone derivatives; Pharmacotherapy; Aripiprazole; Psychosis; 5-HT1A Serotonine receptor; Antagonist; Dibenzothiazepine derivatives; Quetiapine; 5-HT2A serotonin receptor; Human; Therapeutic process; Ziprasidone; Hypnotic; 5-HT2 Serotonine receptor; D2 Dopamine receptor; Treatment; Tranquillizer; First episode; Piperazine derivatives
• ISSN: 0920-9964; 1573-2509
• DOI: 10.1016/j.schres.2013.04.014

Abstract Background Differences among antipsychotics in terms of effectiveness have turned out to be a topic of increasing research interest, although comparisons between the different second generation antipsychotics (SGAs) are scarce. We aimed to compare the clinical effectiveness in the short-term of Aripiprazole, Ziprasidone and Quetiapine in the treatment of first-episode schizophrenia-spectrum disorders. Method From October 2005 to January 2011, a prospective, randomized, open-label study was undertaken. 202 first-episode drug-naïve patients were randomly assigned to Aripiprazole (N = 78), Ziprasidone (N = 62), or Quetiapine (N = 62) and followed-up for 3 months. The primary effectiveness measure was all-cause of treatment discontinuation. In addition, an analysis based on intention-to-treat populations was conducted in the analysis for clinical efficacy. Results The overall dropout rate at 3 months was small (13.86%). The treatment discontinuation rate differed significantly between treatment groups (Aripiprazole = 23.1%, Ziprasidone = 37.1% and Quetiapine = 61.3%) (χ2 = 21.334; p < 0.001). Insufficient efficacy in the group of Quetiapine is the main reason for discontinuation rate differences (χ2 = 20.223; p < 0.001). The mean time to all-cause discontinuation was significantly different between groups (LogRank = 23.467 p < 0.001). Aripiprazole and Quetiapine were associated with a greater depressive symptoms improvement (p = 0.043). The profile of side-effects varies between treatments. Patients on Quetiapine were less likely to be prescribed hypnotics. Conclusions Patients treated with Quetiapine had a higher risk of treatment discontinuation in the short-term after a first episode due to insufficient efficacy. Establishing differences between SGAs may help clinicians in prescribing decisions for the treatment of individuals presenting with first-episode schizophrenia.