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.

1.Swartz MS: Introduction to the CATIE special section. Psychiatric Services 59: 497–499, 2008.2.Swartz MS, Stroup TS, McEvoy JP, et al: What CATIE found: results from the schizophrenia trial. Psychiatric Services 59:500–506, 20083.Davis JM, Chen N, Glick ID: A meta-analysis of the efficacy of second-generation antipsychotics. Archives of General Psychiatry 60:553–564, 2003.4.Lieberman JA, Stroup TS, McEvoy JP, et al: Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. NEJM 353:1209–1223, 2005