Psychiatrists, MDs Ignore CATIE, Keep Prescribing Atypicals
My old hometown newspaper, The News Journal (Wilmington, Del.) had a nice write-up of Seroquel’s big explosion in prescriptions over the past decade. Seroquel is made by one of Delaware’s biggest private employers, AstraZeneca, hence the local angle.
But apparently, despite a large-scale, objective clinical trial (CATIE) calling into question the effectiveness of these newer, supposedly “better” atypical antipsychotic medications, prescribing habits don’t seem to have changed much:
The 18-month study, conducted on more than 1,400 participants with schizophrenia, found that the atypicals were no more effective than the older, cheaper drug. A 60-day supply of the recommended dosage of Seroquel costs $605.88 on Drugstore.com; a 60-day supply of perphenazine costs $24.99.
The CATIE trials also found that nearly 75 percent of patients switched medications before the end of the trials, either because the drugs were ineffective or patients couldn’t tolerate them.
Only 18 percent of patients on Seroquel stayed on the drug for the full course of the trial, the worst rate among the five drugs. Zyprexa performed better than the other drugs, but caused the greatest amount of weight gain and metabolic changes. […]
Robert Rosenheck, a psychiatry professor at Yale and a co-investigator in the CATIE trials, said he’s seen no attitude change among psychiatrists toward the atypicals, in spite of CATIE and other studies that show similar results. Doctors, he said, have been swayed by drug company marketing programs and industry-sponsored research.
“You had 10 to 15 years of marketing in which the companies controlled the journal publications, controlled the speakers bureaus, controlled the dinners, controlled the patient advocacy groups, all of which communicated these drugs were a breakthrough,” Rosenheck said. “But there was little independent research.”
CATIE was not sponsored by a pharmaceutical company, so its results are ostensibly more objective and reliable than those 10 to 15 years’ worth of prior studies. But you also don’t just throw away 15 years’ previous research either.
I’m not sure if the information just hasn’t filtered down to prescribing docs or what, but this is just ridiculous. You don’t prescribe a medication just because it’s “newer.” You prescribe it because it’s more effective or has less side effects. The CATIE study clearly showed newer medications in this class have little evidence to stand on with regards to their greater effectiveness, tolerability, or lesser side effect profiles.
Why does any of this matter?
AstraZeneca is seeking FDA approval to treat major depressive disorder and generalized anxiety disorder with Seroquel XR, a once-daily formulation of the drug. Seroquel XR would be the first atypical approved to treat depression and anxiety. The company has completed pediatric trials of Seroquel at the FDA’s request. The results have not been made public. Risperdal and Abilify, two competing atypicals, are approved for limited uses in pediatric patients. Seroquel’s patent expires in 2011, while Seroquel XR is protected until 2017. AstraZeneca won a court battle in July that should protect Seroquel from generic competition before its patent expires; the extended-release version is seen as a way to extend sales past 2011.
Ahh, despite producing 870.7 million Seroquel tablets and 18.3 million Seroquel XR tablets last year, the drugmaker needs to expand its marketplace and broaden its horizons.
Sorry, but if the result of one treatment is a significantly increased risk of diabetes (and lifelong treatment for that disease), one really has to take a long hard look before taking some of these medications.
Don’t get me wrong — I think Seroquel is a great drug. But it hasn’t demonstrated anything unique about it that suggests it is a better drug than what is already available for depression and generalized anxiety disorder. And given that few people remain on any antipsychotic for very long, this seems like chasing marketshare for the purpose of increasing profits, not decreasing suffering.
Hat tip: Furious Seasons
Read the full article: AstraZeneca defends drug’s soaring sales
Grohol, J. (2008). Psychiatrists, MDs Ignore CATIE, Keep Prescribing Atypicals. Psych Central. Retrieved on September 21, 2017, from https://psychcentral.com/blog/archives/2008/08/09/psychiatrists-mds-ignore-catie-keep-prescribing-atypicals/