In 2008, Beitinger and colleagues reanalyzed six antipsychotic trials (n=2463) of patients with schizophrenia comparing two sets of remission criteria12: the RSWG criteria (full criteria in the three scientific assay mid-term to long-term studies; 28 to 52 weeks) using scores of ≤3 (“mild” or better), ≤2 (“very mild” or better) or 1 (“not present”) and the Lieberman criteria. Applying the RSWG criteria to the mid-term studies with or without time criterion resulted in Inhibitors,research,lifescience,medical the following frequencies:
scores ≤3 (LOCF): 42%/11%, ≤2 (LOCF): 16%/1.8%, 1 (LOCF): 3.4%/0%; in the long-term studies with or without time criterion: scores ≤ 3 (LOCF): 42%/11%, ≤ 2 (LOCF): 13%/2%, 1 (LOCF): 5%/1%. Compared with the remission criteria by Inhibitors,research,lifescience,medical Lieberman, the RSWG remission criteria were less restrictive (week 28: 38% vs 60%). The authors concluded that the results of more stringent thresholds within the proposed remission criteria (scores of ≤2 or lower) show that a score of mild or better is a “realistic choice, more stringent thresholds yield remission frequencies are
not realistic.” In 2009, Cassidy et al tested four sets of remission criteria in 141 first-episode psychosis (FEP) patients for prediction of functioning at the 2-year end point13: (i) all SAPS positive items (hallucinations, delusions, bizarre behavior, positive formal thought Inhibitors,research,lifescience,medical disorder) Inhibitors,research,lifescience,medical rated ≤2 (severity) for 3 reference consecutive months; (ii) all SAPS positive items rated ≤2 for 6 consecutive months; (iii) all SAPS positive and negative items (affective flattening, alogia, avolition-apathy, anhedonia-asociality) rated ≤2 for 3 consecutive months; (iv) all SAPS positive and negative items rated ≤2 for 6 consecutive months. Totals of 94% and 84% of subjects for 3 and 6 months achieved positive symptom remission, compared with 70% and 56% for positive and negative symptom remission, respectively. Linear Inhibitors,research,lifescience,medical regression analyses showed that only remission criteria containing both positive and
negative symptom criteria independently predicted functional outcome. The authors concluded that consistent with the consensus definition of remission, severity of both positive and negative symptoms AV-951 is necessary although a 3month criterion had equal predictive validity to a 6month criterion. In summary, the following conclusions were able to be drawn: The new remission criteria by Andreasen et al1 are less stringent than the remission criteria by Lieberman et al8 and more stringent than the remission criteria by Liberman et al.11 A higher stringency means that fewer patients will fulfill the remission criteria, but if fulfilled, the patients have a better clinical status. It is therefore likely that remission criteria with higher stringency will display a better predictive validity for a broader outcome.