title: Effectiveness of antipsychotics in first-episode schizophrenia and schizophreniform disorder on response and remission: an open randomized clinical trial (EUFEST).
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 >or=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 (1-4 mg/d; n=103), amisulpride (200-800 mg/d; n=104), olanzapine (5-20mg/d; n=105), quetiapine (200-750 mg/d; n=104), or ziprasidone (40-160 mg/d; n=82). Primary outcomes were >or=50% response and remission within 12 months, as measured with the Positive and Negative Syndrome Scale. Analysis was by intention-to-treat.
  
  
  RESULTS
  Within 12 months, the proportions of patients with >or=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 >or=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 12 months, 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 12 months. The proportions of response and remission were higher for most SGAs as compared to haloperidol.
authors.affiliation: Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, The Netherlands. h.boter@epi.umcg.nl
authors.forename: Han
authors.initials: H
authors.lastname: Boter
authors.forename: Joseph
authors.initials: J
authors.lastname: Peuskens
authors.forename: Jan
authors.initials: J
authors.lastname: Libiger
authors.forename: W Wolfgang
authors.initials: WW
authors.lastname: Fleischhacker
authors.forename: Michael
authors.initials: M
authors.lastname: Davidson
authors.forename: Silvana
authors.initials: S
authors.lastname: Galderisi
authors.forename: René S
authors.initials: RS
authors.lastname: Kahn
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003431:Cross-Cultural Comparison; D004305:Dose-Response Relationship, Drug; D005060:Europe; D005260:Female; D006801:Humans; D007391:International Cooperation; D007557:Israel; D008297:Male; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000188:drug therapy*; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy*; D055502:Secondary Prevention; D013997:Time Factors; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents