Methods	Allocation: random, no further details. Blindness: double, identical capsules. Duration: 78 weeks. Design: parallel. Location: multicentre.
Participants	Diagnosis: (DSM-IV) schizophrenia, more than one schizophrenic episode, responder. N=1493. Age: 18-65 years (mean=40.6 years). Gender: 1080 M, 380 F. History: duration of illness not reported, age at onset not reported. Setting: in- and outpatient.
Interventions	Olanzapine: flexible dose, allowed dose range: 7.5-30 mg/day, mean dose=20.1 mg/day. N=336. Perphenazine: flexible dose, allowed dose range: 8-32 mg/day, mean dose=20.8 mg/day. N=261. Quetiapine: flexible dose, allowed dose range: 200-800 mg/day, mean dose=543.4 mg/day. N=337. Risperidone: flexible dose, allowed dose range: 1.5-6.0 mg/day, mean dose=3.9 mg/day. N=341. Ziprasidone: flexible dose, allowed dose range: 40-160 mg/day, mean dose=112.8 mg/day. N=185
Outcomes	Leaving the study early: any reason, adverse events, inefficacy. Global State: CGI-S Mental State: PANSS total score Service use: number of patients re-hospitalised. Death: suicide attempt. Adverse effects: open interviews, EPS (use of antiparkinson medication, akathisia), cardiac effects (ECG), prolactin-associated side-effects, sedation, weight gain, laboratory (prolactin, lipids, glucose) Unable to use- Withdrawal due to ’extrapyramidal effects’ (no usable data).
Notes	33 patients were excluded before analysis.
Risk of bias
Bias	Authors’ judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Random, no further details.
Allocation concealment (selection bias)	Unclear risk	No further details.
Blinding (performance bias and detection bias) Subjective outcomes	Unclear risk	Double, identical capsules. Whether blind-ing was successful has not been examined, but both compounds differ quite substantially in side-effects. This can be a problem for blinding
Blinding (performance bias and detection bias) Objective outcomes	Low risk	Objective outcomes such as laboratory measures or death are unlikely to have been much affected by problems of blinding
Incomplete outcome data (attrition bias) All outcomes	High risk	The attrition was extremely high (75%) , and it is unclear whether any statistical method can account for such a high dropout rate. Efficacy outcomes were evaluated based on mixed models analysis
Selective reporting (reporting bias)	Low risk	No evidence for selective reporting.
Other bias	Unclear risk	Dose ranges were quite different, the upper dose range of olanzapine was 30 mg whereas risperidone could only be titrated up to 6 mg /day. No wash-out period. An overlap in the administration of formerly given antipsychotics was permitted for the first four weeks after randomisation. Allocation to ziprasidone treatment was not possible from the start of the study because ziprasidone was only available at later stages