The promise and pitfalls of antipsychotic co-initiation in schizophrenia

Abstract

In this issue of The Lancet Psychiatry, Christian Schmidt-Kraepelin and colleagues1 report an important large-scale 16-week double-blind randomised controlled trial (COMBINE study) examining the efficacy and tolerability of a combination of amisulpride plus olanzapine versus amisulpride or olanzapine monotherapy, in patients with multiple-episode symptomatic schizophrenia. They demonstrated the superiority of the combination therapy to olanzapine for improvement in total symptom severity at 8 weeks, but not at 16 weeks, and inferiority to amisulpride for metabolic and sexual side effects, suggesting that this combination is beneficial in situations requiring prompt improvement in symptoms.