title: Aripiprazole, Ziprasidone and Quetiapine in the treatment of first-episode nonaffective psychosis: a 12-week randomized, flexible-dose, open-label trial.
abstract: BACKGROUND
  Differences among antipsychotics in terms of effectiveness have turned out to be a topic of increasing research interest, although comparisons between the different second generation antipsychotics (SGAs) are scarce. We aimed to compare the clinical effectiveness in the short-term of Aripiprazole, Ziprasidone and Quetiapine in the treatment of first-episode schizophrenia-spectrum disorders.
  
  
  METHODS
  From October 2005 to January 2011, a prospective, randomized, open-label study was undertaken. 202 first-episode drug-naïve patients were randomly assigned to Aripiprazole (N = 78), Ziprasidone (N = 62), or Quetiapine (N = 62) and followed-up for 3 months. The primary effectiveness measure was all-cause of treatment discontinuation. In addition, an analysis based on intention-to-treat populations was conducted in the analysis for clinical efficacy.
  
  
  RESULTS
  The overall dropout rate at 3 months was small (13.86%). The treatment discontinuation rate differed significantly between treatment groups (Aripiprazole = 23.1%, Ziprasidone = 37.1% and Quetiapine = 61.3%) (χ(2) = 21.334; p < 0.001). Insufficient efficacy in the group of Quetiapine is the main reason for discontinuation rate differences (χ(2) = 20.223; p < 0.001). The mean time to all-cause discontinuation was significantly different between groups (LogRank = 23.467 p < 0.001). Aripiprazole and Quetiapine were associated with a greater depressive symptoms improvement (p = 0.043). The profile of side-effects varies between treatments. Patients on Quetiapine were less likely to be prescribed hypnotics.
  
  
  CONCLUSIONS
  Patients treated with Quetiapine had a higher risk of treatment discontinuation in the short-term after a first episode due to insufficient efficacy. Establishing differences between SGAs may help clinicians in prescribing decisions for the treatment of individuals presenting with first-episode schizophrenia.
authors: University Hospital Marqués de Valdecilla, IFIMAV, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain. bcfacorro@humv.es
authors: Benedicto
authors: B
authors: Crespo-Facorro
authors: Victor
authors: V
authors: Ortiz-García de la Foz
authors: Ignacio
authors: I
authors: Mata
authors: Rosa
authors: R
authors: Ayesa-Arriola
authors: Paula
authors: P
authors: Suarez-Pinilla
authors: Elsa M
authors: EM
authors: Valdizan
authors: José Luis
authors: JL
authors: Vázquez-Barquero
authors: Rocío
authors: R
authors: Pérez-Iglesias
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D000068180:Aripiprazole; D003987:Dibenzothiazepines / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010879:Piperazines / Q000627:therapeutic use; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000188:drug therapy*; D000069348:Quetiapine Fumarate; D015363:Quinolones / Q000627:therapeutic use; D012189:Retrospective Studies; D013844:Thiazoles / Q000627:therapeutic use; D013997:Time Factors; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D010879:Piperazines; D015363:Quinolones; D013844:Thiazoles; D000069348:Quetiapine Fumarate; C092292:ziprasidone; D000068180:Aripiprazole