Korean J Schizophr Res.  2016 Apr;19(1):17-24. 10.16946/kjsr.2016.19.1.17.

Reason for Clozapine Discontinuation

• Cho JW
• Kim WH
• Shin JH
• Kim JH
• Lee JS
• Bae JN
• Kim CE

• KMID: 2344026
• DOI: http://doi.org/10.16946/kjsr.2016.19.1.17

Abstract

OBJECTIVES
Approximately 30% of individuals diagnosed with schizophrenia suffer from treatment-resistant schizophrenia. Clozapine is underutilized in the management of treatment-resistant schizophrenia. To understand contributing factors, we analyzed the time course and causes of clozapine discontinuations that occurred over a 20-year period in a clinical setting.
METHODS
The reasons for discontinuation and duration of clozapine treatment from a retrospective database of 138 patients with schizophrenia who had prescribed clozapine at least a month were reviewed, with the motives for discontinuation coded. The causes for termination were analyzed.
RESULTS
Over two-thirds of the patient had ceased clozapine. The two most common causes for discontinuation were side-effects (50%), and own decision (30%). Somnolence accounted for 34% of all side-effects induced discontinuations. Hematological problems accounted for 23% of side-effect. The Maximal treatment dose of clozapine was higher in continuation group (442.36 mg) than in discontinuation group (397.26 mg). The CGI-S score when prescribing clozapine last was higher in discontinuation group than in continuous group. The patients who took atypical antipsychotics before clozapine tended to cease clozapine because of side-effects than who took typical agent.
CONCLUSION
Future studies should seek various methods to relieve side-effects of clozapine. Prospective researches using more objective tools are needed to clarify the reason for clozapine discontinuation.

Keyword

Schizophrenia; Clozapine; Antipsychotics; Treatment discontinuation; Side-Effect

MeSH Terms

Antipsychotic Agents
Clozapine*
Humans
Prospective Studies
Retrospective Studies
Schizophrenia
Antipsychotic Agents
Clozapine

Figure

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  Fig. 1. Kaplan-Meier Survival plot for time to discontinuation.

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  Fig. 2. Number of patients ceasing clozapine by general reason and treatment duration.

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  Fig. 3. Number of patients ceasing clozapine for medical reasons by treatment duration.

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