Amisulpride and olanzapine followed by open-label treatment with clozapine in first-episode schizophrenia and schizophreniform disorder (OPTiMiSE): a three-phase switching study
Kahn RS, Winter van Rossum I, et al. Lancet. Published online:August 13, 2018 DOI:https://doi.org/10.1016/S2215-0366(18)30252-9
This three-phase study conducted in 27 European centres investigated the value of reducing a currently used three-step treatment algorithm for first episode psychosis (Amisulpiride to Olanzapine to Clozapine) to two steps (Amisulpiride to Clozapine). The authors conclude that the two-step algorithm leads to the same degree of remission as the three-step algorithm, suggesting the intermediate step (Olanzapine) may not be necessary. It will be interesting to see how this study influences future treatment guidelines.
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30252-9/fulltext