Korean J Schizophr Res.  2019 Apr;22(1):1-7. 10.16946/kjsr.2019.22.1.1.

Prescribing Pattern of Clozapine and Clinical Factors associated with Discontinuation of Clozapine

Affiliations
  • 1Department of Adult Psychiatry, National Center for Mental Health, Seoul, Korea. drshe@hanmail.net

Abstract


OBJECTIVES
Clozapine is the drug of choice in treatment-resistant schizophrenia. However, its use is often delayed and a significant proportion of clozapine treated patients fails to respond and experience potentially dangerous side-effects. The aim of this retrospective study was to describe the clinical characteristics of patients started on clozapine and the rate and reason of discontinuation of clozapine.
METHODS
Medical records of 83 patients started on clozapine during the period of 2012-2016 were reviewed.
RESULTS
Clozapine started on patients in chronic phase; the mean age of start was 38.1 years old and the mean number of psychiatric admission was 6.5. A majority (80.7%) of the patients had been subjected to antipsychotic polypharmacy prior to clozapine and most (61.5%) of them were being treated with polypharmacy including clozapine. Overall, 39 (47.0%) subjects had continued clozapine whereas 15 (18.1%) discontinued it; 29 (34.9%) were lost to follow-up. The most common reason for discontinuation was side-effects (n=13) including six life-threatening cases, most of which occurred within 6 months of its start.
CONCLUSION
This study demonstrated that there is some evidence of delays to clozapine use, high rates of polypharmacy and significant rate of discontinuation during the early phase of clozapine treatment.

Keyword

Clozapine; Antipsychotics; Prescribing pattern; Discontinuation; Side effect

MeSH Terms

Antipsychotic Agents
Clozapine*
Humans
Lost to Follow-Up
Medical Records
Polypharmacy
Retrospective Studies
Schizophrenia
Antipsychotic Agents
Clozapine

Cited by  3 articles

Change of Prescribing Pattern after Clozapine Discontinuation: A Retrospective Chart Review
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Korean J Schizophr Res. 2021;24(1):36-43.    doi: 10.16946/kjsr.2021.24.1.36.

Effect of Delayed Clozapine Initiation on Acute Treatment Response in Treatment-Resistant Schizophrenia
So Yung Yang, Jung-Kyu Choi, Sunyoung Park, Jaesub Park
Korean J Schizophr Res. 2021;24(2):52-59.    doi: 10.16946/kjsr.2021.24.2.52.

Clozapine Dose-Concentration Relationship and Other Factors Associated With Clozapine Plasma Concentration in Korean Schizophrenia Patients
Seonghyeon Ryu, Gyeonghyeong Cho
Korean J Schizophr Res. 2023;26(2):46-51.    doi: 10.16946/kjsr.2023.26.2.46.


Reference

1. National Collaborating Centre for Mental Health (UK) Psychosis and Schizophrenia in Adults. Treatment and Management: Updated Edition 2014. London: National Institute for Health and Care Excellence (UK);2014.
2. McIlwain ME, Harrison J, Wheeler AJ, Russell BR. Pharmacotherapy for treatment-resistant schizophrenia. Neuropsychiatr Dis Treat. 2011; 7:135–149.
3. Lewis SW, Barnes TR, Davies L, Murray RM, Dunn G, Hayhurst KP, et al. Randomized controlled trial of effect of prescription of clozapine versus other second-generation antipsychotic drugs in resistant schizophrenia. Schizophr Bull. 2006; 32:715–723.
Article
4. McEvoy JP, Lieberman JA, Stroup TS, Davis SM, Meltzer HY, Rosenheck RA, et al. Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. Am J Psychiatry. 2006; 163:600–610.
Article
5. Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005; 353:1209–1223.
Article
6. Wheeler A, Humberstone V, Robinson G. Outcomes for schizophrenia patients with clozapine treatment: how good does it get? J Psychopharmacol. 2009; 23:957–965.
Article
7. Duggan A, Warner J, Knapp M, Kerwin R. Modelling the impact of clozapine on suicide in patients with treatment-resistant schizophrenia in the UK. Br J Psychiatry. 2003; 182:505–508.
Article
8. Brunette MF, Drake RE, Xie H, McHugo GJ, Green AI. Clozapine use and relapses of substance use disorder among patients with co-occurring schizophrenia and substance use disorders. Schizophr Bull. 2006; 32:637–643.
Article
9. Stahl SM. Clozapine: is now the time for more clinicians to adopt this orphan? CNS Spectr. 2014; 19:279–281.
Article
10. Howes OD, Vergunst F, Gee S, McGuire P, Kapur S, Taylor D. Adherence to treatment guidelines in clinical practice: study of antipsychotic treatment prior to clozapine initiation. Br J Psychiatry. 2012; 201:481–485.
Article
11. Tungaraza TE, Farooq S. Clozapine prescribing in the UK: views and experience of consultant psychiatrists. Ther Adv Psychopharmacol. 2015; 5:88–96.
Article
12. Ucok A, Cikrikcili U, Karabulut S, Salaj A, Ozturk M, Tabak O, et al. Delayed initiation of clozapine may be related to poor response in treatment-resistant schizophrenia. Int Clin Psychopharmacol. 2015; 30:290–295.
Article
13. Yoshimura B, Yada Y, So R, Takaki M, Yamada N. The critical treatment window of clozapine in treatment-resistant schizophrenia: Secondary analysis of an observational study. Psychiatry Res. 2017; 250:65–70.
Article
14. Porcelli S, Balzarro B, Serretti A. Clozapine resistance: augmentation strategies. Eur Neuropsychopharmacol. 2012; 22:165–182.
Article
15. Siskind D, Siskind V, Kisely S. Clozapine response rates among people with treatment-resistant schizophrenia: data from a systematic review and meta-Analysis. Can J Psychiatry. 2017; 62:772–777.
Article
16. Wagner E, Lohrs L, Siskind D, Honer WG, Falkai P, Hasan A. Clozapine augmetation strategies-a systematic meta-review of available evidence. Treatment options for clozapine resistance. J Psychopharmacol. 2019; 30:Epub ahead of print.
17. Muscatello MRA, Bruno A, Fazio PD, Segura-Garcia C, Fandolfo G, Zoccali R. Augmentation strategies in partial responder and/or treatment-resistant schizophrenia patients treated with clozapine. Expert Opin Pharmacother. 2014; 15:2329–2345.
Article
18. Berardis DD, Rapini G, Olivieri L, Nicola DD, Tomasetti C, Valchera A, et al. Safety of antipsychotics for the treatment of schizophrenia: a focus on the adverse effects of clozapine. Ther Adv Drug Saf. 2018; 9:237–256.
Article
19. Kang SH, Lee JI. Eosinophilia, pleural effusion, hepatitis, and jaundice occuring early in clozapine treatment. Clin Psychopharmacol Neurosci. 2013; 11:103–105.
Article
20. Thien K, O'Donoghue B. Delays and barriers to the commencement of clozapine in eligigble people with a psychotic disorder: a literature rievew. Early Interv Psychiatry. 2019; 13:18–23.
Article
21. Agid O, Remington G, Kapur S, Arenovich T, Zipursky RB. Early use of clozapine for poorly responding first-episode psychosis. J Clin Psychopharmacol. 2007; 27:369–373.
Article
22. Thien K, Bowtell M, Eaton S, Bardell-Williams M, Downey L, Ratheesh A, et al. Clozapine use in early psychosis. Schizophr Res. 2018; 199:374–379.
Article
23. Cho J, Kim W, Shin J, Kim JH, Lee JS, Bea JN. Reason for clozapine discontinuation. Korean J Schizophr Res. 2016; 19:17–24.
Article
24. Hayhurst KP, Brown P, Lewis SW. Postcode prescribing for schizophrenia. Br J psychiatry. 2003; 182:281–283.
Article
25. Hayhurst KP, Brown P, Lewis SW. The cost-effectiveness of clozapine: a controlled, population-based, mirror-image study. J Psychopharmacol. 2002; 16:169–175.
Article
26. Munro J, O'Sullivan D, Andrews C, Arana A, Mortimer A, Kerwin R. Active monitoring of 12,760 clozapine recipients in the UK and Ireland. Beyond pharmacovigilance. Br J Psychiatry. 1999; 175:576–580.
Article
27. Davis MC, Fuller MA, Strauss ME, Konicki PE, Jaskiw GE. Discontinuation of clozapine: a 15-year naturalistic retrospective study of 320 patients. Acta Psychiatr Scand. 2014; 130:30–39.
Article
28. Pai NB, Vella SC. Reason for clozapine cessation. Acta Psychiatr Scand. 2012; 125:39–44.
Article
29. Ciapparelli A, Dell'Osso L, Bandettini di Poggio A, Carmassi C, Cecconi D, Fenzi M, et al. Clozapine in treatment-resistant patients with schizophrenia, schizoaffective disorder, or psychotic bipolar disorder: a naturalistic 48-month follow-up study. J Clin Psychiatry. 2003; 64:451–458.
Article
30. Laker MK, Duffett RS, Cookson JC. Long-term outcome with clozapine: comparison of patients continuing and discontinuing treatment. Int Clin Psychopharmacol. 1998; 13:75–78.
31. Harrison J, Janlov M, Wheeler AJ. Patterns of clozapine prescribing in a mental health service in New Zealand. Pharm World Sci. 2010; 32:503–511.
Article
32. Dold M, Leucht S. Pharmacotherapy of treatment-resistant schizophrenia: a clinical perspective. Evid Based Ment Health. 2014; 17:33–37.
Article
33. Chang JS, Ahn YM, Park HJ, Lee KY, Kim SH, Kang UG, et al. Aripiprazole augmentation in clozapine-treated patients with refractory schizophrenia: an 8-week, randomized, double-blind, placebo-controlled trial. J Clin Psychiatry. 2008; 69:720–731.
Article
34. Muscatello MR, Bruno A, Pandolfo G, Mico U, Belllinghieri PM, Scimeca G, et al. Effect of aripiprazole augmentation of clozapine in schizophrenia: a double-blind, placebo-controlled study. Schizophr res. 2011; 127:93–99.
Article
35. Zheng W, Xiang YT, Yang XH, Xiang YQ, de Leon J. Clozapine Augmentation With Antiepileptic Drugs for Treatment-Resistant Schizophrenia: A Meta-Analysis of Randomized Controlled Trials. J Clin Psychiatry. 2017; 78:e498–e505.
36. Leucht S, Kissling W, McGrath J. Lithium for schizophrenia revisited: a systematic review and meta-analysis of randomized controlled trials. J Clin Psychiatry. 2004; 65:177–186.
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