The $42.6 million Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study directly compared second-generation antipsychotics with older drugs. Total monthly health costs were up to 30% lower for those taking the older drug perphenazine than for those taking the second generation medications, yet the researchers found no statistically significant difference in overall effectiveness between perphenazine and the second generation antipsychotics.
“The results from CATIE should encourage doctors to reconsider the use of perphenazine as another choice for patients with schizophrenia,” said NIMH director Thomas Insel.
More than 90% of antipsychotic prescriptions are written for second generation medications, despite the fact they are more expensive than the first generation agents used to treat schizophrenia. The majority of clinicians have traditionally believed that the newer antipsychotics are more effective and better tolerated than older agents, and many experts argued that these advantages justified the difference in cost.
The researchers said that the trial casts doubt on the notion that the second generation antipsychotics are better than the first generation antipsychotics, and suggests that perphenazine and other first generation antipsychotics may be just as beneficial for some patients. A recent study in the UK has reported similar results.