Noninferiority of perphenazine vs. three second-generation antipsychotics in chronic schizophrenia

Robert Rosenheck, Haiqun Lin

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Noninferiority analysis is a statistical method of growing importance in comparative effectiveness research that has rarely been used in psychopharmacology. This method is used here to evaluate whether first-generation antipsychotics are clinically not inferior to second-generation antipsychotics (SGAs) using data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE). A conservative noninferiority margin (NIM) on the Positive and Negative Syndrome Scale (PANSS) was derived from the smallest published value for the minimal clinically important difference, further reduced by 25%. This NIM was used to assess whether perphenazine is noninferior to olanzapine, risperidone, and quetiapine on the basis of the 95% confidence intervals of differences in mean PANSS outcomes (N = 1049). Perphenazine was noninferior to all three SGAs during 18 months of intention-to-treat analysis and in several subanalyses. Noninferiority can be evaluated from studies designed as superiority trials. Power was available in the CATIE to conduct noninferiority analysis.

Original languageEnglish (US)
Pages (from-to)18-24
Number of pages7
JournalJournal of Nervous and Mental Disease
Issue number1
StatePublished - Jan 2014
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Psychiatry and Mental health


  • Antipsychotics
  • Noninferiority analysis
  • Schizophrenia


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