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Letters to the Editor

Dr Kantrowitz and Colleagues Reply

Joshua T. Kantrowitz, MD; Alice Medalia, PhD; Richard S. E. Keefe, PhD; Philip D. Harvey, PhD; Gerard Bruder, PhD; Deanna M. Barch, PhD; Tse Choo, MPH; Seonjoo Lee, PhD; and Jeffrey A. Lieberman, MD

Published: October 26, 2016

See letter by Siu and Agid and article by Kantrowitz et al

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Dr Kantrowitz and Colleagues Reply

To the Editor: We thank Drs Siu and Agid for their interest in our recent report.1 Treating cognitive impairments in schizophrenia is important, and we hope to encourage continued research in this area.

Drs Siu and Agid raise several important points of emphasis that we have already covered in detail in our published report. We strongly agree with their assertion that we "should acknowledge the significant improvement in MCCB scores associated with lurasidone treatment in the stabilization phase," as we did so in Table 1 in our published report. We felt that the continued across-group improvement over the full study was also worthy of highlighting. Our reference to the 0.42 effect size was limited to this purpose. One-sample tests were not used to assess the effect of auditory processing-focused cognitive remediation.

Drs Siu and Agid suggest that we should have focused on the fact that this improvement occurred during open-label lurasidone treatment. We agree that a procognitive impact of lurasidone is possible, and we noted this in the abstract and devoted a subsection in the Discussion to this possibility entitled "Impact of Lurasidone." However, we concluded that a direct relationship between lurasidone and cognitive improvement was possible but difficult to clearly interpret from the results of this study because, as we pointed out, "all participants were receiving lurasidone open label," in contrast to the placebo-controlled, randomized study2 cited by Drs Siu and Agid.

Additionally, we also agree that the "between-group difference at randomization," mentioned by Siu and Agid, in several MCCB domains was important to highlight. Accordingly, the trend-level difference was mentioned in the abstract Results subsection and, moreover, discussed at length in the Results and in a subsection of the Discussion entitled "Between-Group Differences at Randomization."

Finally, we also agree that it was important to highlight that there were no "significant between-group differences" between auditory-focused treatment and nonspecific control "at study completion." In fact, this was also clearly stated in the abstract, Results, and Discussion. The study was limited by having all subjects receive open-label lurasidone, and future studies should consider a 2-by-2 design.


1. Kantrowitz JT, Sharif Z, Medalia A, et al. A multicenter, rater-blinded, randomized controlled study of auditory processing-focused cognitive remediation combined with open-label lurasidone in patients with schizophrenia and schizoaffective disorder. J Clin Psychiatry. 2016;77(6):799-806. PubMed doi:10.4088/JCP.15m09998

2. Harvey PD, Siu CO, Hsu J, et al. Effect of lurasidone on neurocognitive performance in patients with schizophrenia: a short-term placebo- and active-controlled study followed by a 6-month double-blind extension. Eur Neuropsychopharmacol. 2013;23(11):1373-1382. PubMed doi:10.1016/j.euroneuro.2013.08.003

Joshua T. Kantrowitz, MDa

Alice Medalia, PhDa

Richard S. E. Keefe, PhDb

Philip D. Harvey, PhDc

Gerard Bruder, PhDa

Deanna M. Barch, PhDd

Tse Choo, MPHa

Seonjoo Lee, PhDa

Jeffrey A. Lieberman, MDa

aDepartment of Psychiatry, Columbia University, New York, New York

bDepartment of Psychiatry, Duke University Medical Center, Durham, North Carolina

cUniversity of Miami Miller School of Medicine, Miami, Florida

dDepartment of Psychology, Washington University, St Louis, Missouri

Potential conflicts of interest: Potential conflicts of interest are listed in the original article [J Clin Psychiatry 2016;77(6):805].

Funding/support: The study discussed in this letter was supported by an investigator-initiated grant to Dr Lieberman from Sunovion Pharmaceuticals.

J Clin Psychiatry 2016;77(10):e1353

© Copyright 2016 Physicians Postgraduate Press, Inc.

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