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No better solution for antipsychotic treatment with regard to long-term safety and effectiveness
  1. Edward Chia-Cheng Lai1,2,
  2. Yea-Huei Kao Yang1,3
  1. 1Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  2. 2Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
  3. 3Health Outcome Research Center, National Cheng Kung University, Tainan, Taiwan
  1. Correspondence to Dr Edward Chia-Cheng Lai; speedpopo{at}

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What is already known on this topic?

Using various end points, the comparative effectiveness and safety of antipsychotics in patients with schizophrenia and other psychiatric indications have been demonstrated by a number of experimental and observational studies.1 While atypical antipsychotics (AAPs) are indicated more frequently and extensively, their long-term safety in older patients, including the risk of weight gain, metabolic syndrome, cardiovascular and cerebrovascular events, has been a growing concern.2

What does this paper add?

  • The study indicated lack of effectiveness and a high incidence of side effects across the four commonly prescribed AAPs, namely aripiprazole, olanzapine, quetiapine and risperidone. Caution in the use of these drugs is warranted in middle-aged and older patients.

  • The authors designed a pragmatic clinical trial using equipoise-stratified randomisation that allowed the patient and the treating psychiatrist to exclude one or two of the study medications for …

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  • Competing interests None.

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