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Comparing Antipsychotic Treatments for Schizophrenia: A Health State Approach

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Abstract

The overall impact of first and second generation antipsychotics on quality of life and symptoms of people with schizophrenia remains controversial. We applied health state modeling to data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Schizophrenia study, a randomized trial of antipsychotic medications, and evaluated the likelihood of patients moving to more favorable health states over time. We applied K-means clustering to the data to create discrete groupings of patients with symptom and side effect characteristics that were then validated using quality of life measures. We compared cluster distributions across medications at baseline and 6 months after randomization. 1,049 patients were included in the initial cluster analysis. Five health states were identified: (1) low symptoms and low side effects (LS + LSE) (2) low symptoms and obesity (LS + Ob) (3) high symptoms and low side effects (HS + LSE) (4) high symptoms with depression and akathisia (HS + Dp + Ak) and (5) moderate symptoms and high side effects (MS + HSE). Six-month outcomes among patients randomly assigned to perphenazine, olanzapine, risperidone and quetiapine were compared. At baseline, almost 20 % of patients were in the worst health state (HS + Dp + Ak), with greater decreases at 6 months in this health state for perphenazine (9.2 % decrease) and olanzapine (11.1 %) groups compared to risperidone (4.7 %) and quetiapine (6.7 %). This study demonstrated that health state analysis can provide insight into the overall clinical state of patients beyond the mere comparison of average scores and largely confirmed original CATIE findings.

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Acknowledgments

This work was supported in part by a grant from Wyeth Pharmaceuticals (currently Pfizer) and by VA MIRECCC.

Author Disclosure

Catherine Sugar and Lewei (Allison) Lin declare that they have no conflict of interest. Arthur Zbrozek was employed by Wyeth Pharmaceuticals at the time of this study. Robert Rosenheck received partial support for the analyses presented in this paper from Wyeth Pharmaceuticals (currently Pfizer). All authors contributed to and have approved the final manuscript.

Human Rights and Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48109, USA

    Lewei Allison Lin

  2. Department of Psychiatry, Yale University, New Haven, CT, USA

    Robert Rosenheck

  3. VA New England Mental Illness Research and Education Center, West Haven, USA

    Robert Rosenheck

  4. Department of Biostatistics, University of California, Los Angeles, USA

    Catherine Sugar

  5. Semel Institute in the Department of Psychiatry, University of California, Los Angeles, USA

    Catherine Sugar

  6. Global Health Outcomes Assessment, Wyeth Research (Pfizer), Collegeville, PA, USA

    Arthur Zbrozek

Authors
  1. Lewei Allison Lin
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  2. Robert Rosenheck
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  3. Catherine Sugar
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  4. Arthur Zbrozek
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Corresponding author

Correspondence to Lewei Allison Lin.

Appendix 1

Appendix 1

See the Table 5.

Table 5 Clinical and demographic characteristics across medications of sample used for initial clustering
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Lin, L.A., Rosenheck, R., Sugar, C. et al. Comparing Antipsychotic Treatments for Schizophrenia: A Health State Approach. Psychiatr Q 86, 107–121 (2015). https://doi.org/10.1007/s11126-014-9326-2

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  • DOI: https://doi.org/10.1007/s11126-014-9326-2

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