Effectiveness of antipsychotic drugs in patients with chronic schizophrenia: efficacy, safety and cost outcomes of CATIE and other trials.

After the introduction of clozapine in 1990, second-generation-or atypical-antipsychotics were thought to be more effective, safer, and less costly than first-generation-or typical-antipsychotics. However, only limited evidence on the efficacy and safety of atypicals was available. Because of this knowledge gap, the National Institute of Mental Health sponsored the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) to compare first- and second-generation antipsychotics. The CATIE trial found that antipsychotic drug treatments are generally effective overall but have various limitations as reflected by high rates of discontinuation due to both efficacy and tolerability problems. In addition, the trial found that conventional agents with intermediate potency were comparably effective with atypical agents.