Letter

To the Editor: We applaud the special section in the May 2008 issue with commentaries interpreting findings from the landmark Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study ( 1, 2 ). The introduction stated that "the literature suggests little evidence that, with the exception of clozapine, second-generation antipsychotics confer superior efficacy in ameliorating positive and negative symptoms and improving cognition or that they are more tolerable." Our meta-analysis ( 3 ) is one of ten published reports cited at the end of this statement.

For the record, like the animals in Animal Farm, some second-generation antipsychotics—olanzapine, risperidone, and amisulpride—were shown in our analysis to be superior to first-generation antipsychotics. In addition, the report by Lieberman and colleagues ( 4 ) of results from phase I of CATIE showed that olanzapine was superior in efficacy to the first-generation antipsychotic perphenazine. We agree that clozapine is more effective than first-generation antipsychotics and that given the data currently available, the other second-generation antipsychotics—quetiapine, ziprasidone, and aripiprazole—have not been shown to have better efficacy than first-generation agents.