Commentary on: Tiihonen J, Mittendorfer-Rutz E, Majak M, et al. Real-world effectiveness of antipsychotic treatments in a nationwide cohort of 29 823 patients with schizophrenia. JAMA Psychiatry 2017;74:686–693.

What is already known on this topic It is essential to identify differences in efficacy and effectiveness between antipsychotic options to inform treatment decisions in schizophrenia. Presence or absence of superiority has recently been particularly controversial for clozapine and long-acting injectable antipsychotics (LAIs), triggered by contrasting positive, negative and inconsistent meta-analyses of randomised controlled trials (RCTs).1–4 These inconsistencies may have been largely the result of selection bias since patients enrolled in RCTs may have a less severe illness, more insight, greater adherence and an overall better prognosis.4 This selection bias may be particularly important for clozapine and LAIs, which may be most effective in treatment-resistant patients and those with greater likelihood of non-adherence-related poor outcomes.. To read the full article, log in using your NHS OpenAthens details.