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Abstract

Objective

Medication outcome literature in schizophrenia across racial-ethnic groups is sparse, with inconsistent findings. The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study provided an opportunity for exploratory analyses of racial-ethnic outcomes. The study objective was to examine race-ethnicity outcomes for CATIE's main outcome (study discontinuation) and secondary outcomes.

Methods

CATIE participants included whites (non-Hispanic) (N=722), African Americans (N=506), and Hispanics (N=170). Survival analyses and mixed-effects regression modeling were conducted, with adjustment for baseline sociodemographic differences and baseline scores of the secondary outcomes.

Results

Racial-ethnic groups had unique patterns of outcomes. Hispanics were much more likely to discontinue for lack of efficacy from perphenazine (64% versus 42% non-Hispanic whites and 24% African Americans) and ziprasidone (71% versus 40% non-Hispanic whites and 24% African Americans); Hispanics' quality of life also declined on these medications. Non-Hispanic whites were more likely to discontinue for lack of efficacy in general (averaging olanzapine, quetiapine, and risperidone discontinuation rates). African Americans were less likely to continue after the first phase (32% continuing versus 40% for non-Hispanic whites and 41% Hispanics). Discontinuations were driven by research burden, personal issues, and unspecified loss to follow-up. Non-Hispanic whites had higher depression scores during the follow-up period. African Americans had fewer side effects.

Conclusions

CATIE results did not show disparities favoring non-Hispanic whites. CATIE may have provided state-of-the-art treatment and thus reduced disparate treatments observed in community clinics. African Americans discontinued even after consideration of socioeconomic differences. Why perphenazine and ziprasidone may be less effective with Hispanics should be explored.

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Information

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Go to Psychiatric Services
Go to Psychiatric Services

Cover: Sir Charles, Alias Willie Harris, by Barkley Leonnard Hendricks, 1972. Oil on canvas. William C. Whitney Foundation, 1973.19.1. National Gallery of Art, Washington, D.C.

Psychiatric Services
Pages: 570 - 578
PubMed: 23494108

History

Published in print: June 2013
Published online: 15 October 2014

Authors

Details

Jodi Gonzalez Arnold, Ph.D.
Dr. Arnold, Dr. Miller, and Dr. Mintz are affiliated with the Department of Psychiatry and Dr. Mintz is also with the Department of Epidemiology and Biostatistics, University of Texas Health Science Center, 7703 Floyd Curl Dr., Med, Room 730 E-2, San Antonio, TX 78209 (e-mail: [email protected]). Dr. Cañive is with Psychiatry Research at the New Mexico Veterans Affairs Healthcare System, Albuquerque, and the Departments of Psychiatry and Neurosciences, University of New Mexico, Albuquerque. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, West Haven, Connecticut. Dr. Swartz is with the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina.
Alexander L. Miller, M.D.
Dr. Arnold, Dr. Miller, and Dr. Mintz are affiliated with the Department of Psychiatry and Dr. Mintz is also with the Department of Epidemiology and Biostatistics, University of Texas Health Science Center, 7703 Floyd Curl Dr., Med, Room 730 E-2, San Antonio, TX 78209 (e-mail: [email protected]). Dr. Cañive is with Psychiatry Research at the New Mexico Veterans Affairs Healthcare System, Albuquerque, and the Departments of Psychiatry and Neurosciences, University of New Mexico, Albuquerque. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, West Haven, Connecticut. Dr. Swartz is with the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina.
José M. Cañive, M.D.
Dr. Arnold, Dr. Miller, and Dr. Mintz are affiliated with the Department of Psychiatry and Dr. Mintz is also with the Department of Epidemiology and Biostatistics, University of Texas Health Science Center, 7703 Floyd Curl Dr., Med, Room 730 E-2, San Antonio, TX 78209 (e-mail: [email protected]). Dr. Cañive is with Psychiatry Research at the New Mexico Veterans Affairs Healthcare System, Albuquerque, and the Departments of Psychiatry and Neurosciences, University of New Mexico, Albuquerque. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, West Haven, Connecticut. Dr. Swartz is with the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina.
Robert A. Rosenheck, M.D.
Dr. Arnold, Dr. Miller, and Dr. Mintz are affiliated with the Department of Psychiatry and Dr. Mintz is also with the Department of Epidemiology and Biostatistics, University of Texas Health Science Center, 7703 Floyd Curl Dr., Med, Room 730 E-2, San Antonio, TX 78209 (e-mail: [email protected]). Dr. Cañive is with Psychiatry Research at the New Mexico Veterans Affairs Healthcare System, Albuquerque, and the Departments of Psychiatry and Neurosciences, University of New Mexico, Albuquerque. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, West Haven, Connecticut. Dr. Swartz is with the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina.
Marvin S. Swartz, M.D.
Dr. Arnold, Dr. Miller, and Dr. Mintz are affiliated with the Department of Psychiatry and Dr. Mintz is also with the Department of Epidemiology and Biostatistics, University of Texas Health Science Center, 7703 Floyd Curl Dr., Med, Room 730 E-2, San Antonio, TX 78209 (e-mail: [email protected]). Dr. Cañive is with Psychiatry Research at the New Mexico Veterans Affairs Healthcare System, Albuquerque, and the Departments of Psychiatry and Neurosciences, University of New Mexico, Albuquerque. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, West Haven, Connecticut. Dr. Swartz is with the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina.
Jim Mintz, Ph.D.
Dr. Arnold, Dr. Miller, and Dr. Mintz are affiliated with the Department of Psychiatry and Dr. Mintz is also with the Department of Epidemiology and Biostatistics, University of Texas Health Science Center, 7703 Floyd Curl Dr., Med, Room 730 E-2, San Antonio, TX 78209 (e-mail: [email protected]). Dr. Cañive is with Psychiatry Research at the New Mexico Veterans Affairs Healthcare System, Albuquerque, and the Departments of Psychiatry and Neurosciences, University of New Mexico, Albuquerque. Dr. Rosenheck is with the Department of Psychiatry, Yale Medical School, West Haven, Connecticut. Dr. Swartz is with the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina.

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