Effectiveness of antipsychotics in first-episode schizophrenia and schizophreniform disorder on response and remission: An open randomized clinical trial (EUFEST)

Boter, Han; Peuskens, Joseph; Libiger, Jan; Fleischhacker, W. Wolfgang; Davidson, Michael; Galderisi, Silvana; Kahn, René S.; for the EUFEST study group,

doi:10.1016/j.schres.2009.09.019

« Previous Next »Schizophrenia Research
Volume 115, Issue 2 , Pages 97-103, December 2009

Effectiveness of antipsychotics in first-episode schizophrenia and schizophreniform disorder on response and remission: An open randomized clinical trial (EUFEST)

Han Boter
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, The Netherlands
- Corresponding author. Department of Epidemiology (room FA 40), University Medical Centre Groningen, PO Box 30001, NL - 9700 RB Groningen, The Netherlands. Tel.: +31 50 3611808; fax: +31 50 3614493.
Joseph Peuskens
- University Psychiatric Centre, Campus St. Jozef Kortenberg, Katholieke Universiteit Leuven, Leuven, Belgium
Jan Libiger
- Department and Clinic of Psychiatry, Charles University Medical School and Faculty Hospital, Hradec Králové, Czech Republic
W. Wolfgang Fleischhacker
- Department of Biological Psychiatry, Medical University Innsbruck, Innsbruck, Austria
Michael Davidson
- Sheba Medical Center, Tel Hashomer, Israel
Silvana Galderisi
- Department of Psychiatry, University of Naples SUN, Naples, Italy
René S. Kahn
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, The Netherlands
for the EUFEST study group

Received 3 March 2009; received in revised form 3 August 2009; accepted 16 September 2009. published online 12 October 2009.

Abstract

Background

Predefined response and remission criteria may hold more clinical relevance than mean scores on rating scales. We compared the effectiveness of low doses of haloperidol and regular doses of second generation antipsychotics (SGAs) on ≥50% response and remission.

Methods

In an open randomized clinical trial in 14 countries, 498 unselected first-episode patients with schizophrenia were assigned to haloperidol (1–4mg/d; n=103), amisulpride (200–800mg/d; n=104), olanzapine (5–20mg/d; n=105), quetiapine (200–750mg/d; n=104), or ziprasidone (40–160mg/d; n=82). Primary outcomes were ≥50% response and remission within 12months, as measured with the Positive and Negative Syndrome Scale. Analysis was by intention-to-treat.

Results

Within 12months, the proportions of patients with ≥50% response were 37% for haloperidol, 67% for amisulpride, 67% for olanzapine, 46% for quetiapine, and 56% for ziprasidone. Comparisons with haloperidol showed a higher likelihood for ≥50% response with amisulpride (hazard ratio [HR] 2.27, [95% CI 1.51–3.42]), olanzapine (HR 2.07 [1.38–3.10]), and ziprasidone (HR 1.62 [1.02–2.56]). Within 12months, the proportions of patients in remission were 17% for haloperidol, 40% for amisulpride, 41% for olanzapine, 24% for quetiapine, and 28% for ziprasidone. Comparisons with haloperidol showed a better chance for remission on amisulpride (HR 2.49, [95% CI 1.43–4.35]), olanzapine (HR 2.58 [1.48–4.48]), quetiapine (HR 1.96 [1.06–3.64]), and ziprasidone (HR 2.03 [1.07–3.87]).

Conclusions

Substantial proportions of first-episode patients with schizophrenia showed clinically meaningful response and remission rates within 12months. The proportions of response and remission were higher for most SGAs as compared to haloperidol.

Keywords: Schizophrenia, Randomized clinical trial, First-episode patients, Multicenter study, Treatment response, Remission