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Randomized Controlled Trial
. 2008 Oct;193(4):279-88.
doi: 10.1192/bjp.bp.108.050088.

Extrapyramidal side-effects of antipsychotics in a randomised trial

Del D Miller  1 , Stanley N Caroff, Sonia M Davis, Robert A Rosenheck, Joseph P McEvoy, Bruce L Saltz, Silvana Riggio, Miranda H Chakos, Marvin S Swartz, Richard S E Keefe, T Scott Stroup, Jeffrey A Lieberman; Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Investigators
Collaborators, Affiliations
Randomized Controlled Trial

Extrapyramidal side-effects of antipsychotics in a randomised trial

Del D Miller et al. Br J Psychiatry. 2008 Oct.

Abstract

Background: There are claims that second-generation antipsychotics produce fewer extrapyramidal side-effects (EPS) compared with first-generation drugs.

Aims: To compare the incidence of treatment-emergent EPS between second-generation antipsychotics and perphenazine in people with schizophrenia.

Method: Incidence analyses integrated data from standardised rating scales and documented use of concomitant medication or treatment discontinuation for EPS events. Mixed model analyses of change in rating scales from baseline were also conducted.

Results: There were no significant differences in incidence or change in rating scales for parkinsonism, dystonia, akathisia or tardive dyskinesia when comparing second-generation antipsychotics with perphenazine or comparing between second-generation antipsychotics. Secondary analyses revealed greater rates of concomitant antiparkinsonism medication among individuals on risperidone and lower rates among individuals on quetiapine, and lower rates of discontinuation because of parkinsonism among people on quetiapine and ziprasidone. There was a trend for a greater likelihood of concomitant medication for akathisia among individuals on risperidone and perphenazine.

Conclusions: The incidence of treatment-emergent EPS and change in EPS ratings indicated that there are no significant differences between second-generation antipsychotics and perphenazine or between second-generation antipsychotics in people with schizophrenia.

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Figures

Fig. 1
Fig. 1
Kaplan–Meier survival curve of time until parkinsonism event for people with no parkinsonism at baseline.a a. Data from all eligible patients. Perphenazine from data-set I; olanzapine, quetiapine and risperidone are from data-set II; ziprasidone from data-set III.
Fig. 2
Fig. 2
Kaplan–Meier survival curve of time until akathisia event for people with no akathisia at baseline.a a. Data from all eligible patients. Perphenazine data from data-set I; olanzapine, quetiapine and risperidone are from data-set II; ziprasidone from data-set III.
Fig. 3
Fig. 3
Kaplan–Meier survival curve of time until Schooler–Kane tardive dyskinesia for people with no tardive dyskinesia at baseline.a a. Data from all eligible patients. Perphenazine, olanzapine, quetiapine and risperidone are from data-set I; ziprasidone from data-set II.
See this image and copyright information in PMC

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