Association between the examination rate of treatment‐resistant schizophrenia and the clozapine prescription rate in a nationwide dissemination and implementation study

Yasui‐Furukori, Norio; Muraoka, Hiroyuki; Hasegawa, Naomi; Ochi, Shinichiro; Numata, Shusuke; Hori, Hikaru; Hishimoto, Akitoyo; Onitsuka, Toshiaki; Ohi, Kazutaka; Hashimoto, Naoki; Nagasawa, Tatsuya; Takaesu, Yoshikazu; Inagaki, Taisuke; Tagata, Hiromi; Tsuboi, Takashi; Kubota, Chika; Furihata, Ryuji; Iga, Jun‐ichi; Iida, Hitoshi; Miura, Kenichiro; Matsumoto, Junya; Watanabe, Koichiro; Inada, Keiichi; Saito, Kazutaka; Hashimoto, Ryota

doi:10.1002/npr2.12218

Cited by 17 publications

(26 citation statements)

References 19 publications

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“…This study was a continuous, nationwide, cross-sectional study. We performed this study as part of the previously reported EGUIDE project ( Takaesu et al, 2019 ; Iida et al, 2020 ; Hashimoto et al, 2021 ; Numata et al, 2021 ; Furihata et al, 2022 ; Yasui-Furukori et al, 2022 ). We recruited psychiatrists beginning in October 2016.…”

Section: Methodsmentioning

confidence: 99%

“…Antipsychotics are effective in improving symptoms of schizophrenia; however, approximately 30% of patients with schizophrenia do not respond to antipsychotics and develop treatment-resistant schizophrenia (TRS) ( Kane et al, 2019 ). TRS is defined as an insufficient response to or insufficient tolerance to antipsychotics ( Yasui-Furukori et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, we investigated the effectiveness of our educational programs ( Takaesu et al, 2019 ; Numata et al, 2021 ) as well as real-world prescribing patterns and treatment styles associated with nonadherence to the guidelines by assessing prescription rates at discharge for inpatients with schizophrenia or major depressive disorder ( Ichihashi et al, 2020 ; Iida et al, 2020 ; Hashimoto et al, 2021 ). Regarding TRS, we reported that institutions with a low TRS examination rate had a low clozapine prescription rate ( Yasui-Furukori et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

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Clozapine Treatment Is Associated With Higher Prescription Rate of Antipsychotic Monotherapy and Lower Prescription Rate of Other Concomitant Psychotropics: A Real-World Nationwide Study

Ochi

Tagata

Hasegawa

et al. 2022

International Journal of Neuropsychopharmacology

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Background Although clozapine is effective for treatment-resistant schizophrenia (TRS), the rate of clozapine prescription is still low. Although antipsychotic monotherapy is recommended in clinical practice guidelines, the rate of antipsychotic polypharmacy is still high. There is little evidence on whether a clozapine prescription influences changes in the rate of monotherapy and polypharmacy, including antipsychotics and other psychotropics. We therefore hypothesized that the rate of antipsychotic monotherapy in patients with TRS who were prescribed clozapine would be higher than that in patients with schizophrenia who were not prescribed clozapine. Methods We assessed 8306 patients with schizophrenia nationwide from 178 institutions in Japan from 2016 to 2019. We analyzed the psychotropic prescription data at discharge in patients diagnosed with TRS and with no description of TRS (ND-TRS) based on the diagnosis listed in the discharge summary. Results The rate of antipsychotic monotherapy in the TRS with clozapine group (91.3%) was significantly higher than that in the TRS without clozapine group (45.9%; p < 2.0 × 10 -16) and the ND-TRS without clozapine group (54.7%; p < 2.0 × 10 -16). The rate of antipsychotic monotherapy without any other concomitant psychotropics in the TRS with clozapine group (26.5%) was significantly higher than that in the TRS without clozapine group (12.6%; p = 1.1 × 10 -6) and the ND-TRS without clozapine group (17.0%; p = 5.9 × 10 -6). Conclusions Clozapine prescription could be associated with a high rate of antipsychotic monotherapy. Patients will benefit from the correct diagnosis of TRS and thus from proper clozapine prescription.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clozapine Treatment Is Associated With Higher Prescription Rate of Antipsychotic Monotherapy and Lower Prescription Rate of Other Concomitant Psychotropics: A Real-World Nationwide Study

Ochi

Tagata

Hasegawa

et al. 2022

International Journal of Neuropsychopharmacology

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“…To disseminate and implement uniform clinical guidelines, the Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE) project was started in 2016 ( 24 – 31 ). The EGUIDE project started with the cooperation of 22 hospitals, and as of 2021, more than 240 hospitals (44 universities) have participated.…”

Section: Introductionmentioning

confidence: 99%

Prescription of Anticholinergic Drugs in Patients With Schizophrenia: Analysis of Antipsychotic Prescription Patterns and Hospital Characteristics

et al. 2022

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In several clinical guidelines for schizophrenia, long-term use of anticholinergic drugs is not recommended. We investigated the characteristics of the use of anticholinergics in patients with schizophrenia by considering psychotropic prescription patterns and differences among hospitals. A cross-sectional, retrospective prescription survey at the time of discharge was conducted on 2027 patients with schizophrenia from 69 Japanese hospitals. We examined the relations among psychotropic drug prescriptions regarding anticholinergic prescription. We divided the hospitals into three groups—low rate group (LG), medium rate group (MG), and high rate group (HG)—according to their anticholinergic prescription rates, and analyzed the relationship between anticholinergic prescription rates and antipsychotic prescription. Anticholinergic drugs were prescribed to 618 patients (30.5%), and the prescription rates were significantly higher for high antipsychotic doses, antipsychotic polypharmacy, and first-generation antipsychotics (FGAs) use. The anticholinergic prescription rate varied considerably among hospitals, ranging from 0 to 66.7%, and it was significantly higher in patients with antipsychotic monotherapy, antipsychotic polypharmacy, and normal and high doses of antipsychotics in HG than in those LG and MG. The anticholinergics prescription rate in patients with second-generation antipsychotic monotherapy in HG was also significantly higher than in those LG and MG; however, the difference was no longer significant in patients with FGA monotherapy. Conclusively, in addition to high antipsychotic doses, antipsychotic polypharmacy, and FGA use, hospital characteristics influence the prescribing of anticholinergic drugs.

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“…14 Up to 81% of a study cohort of Japanese patients with chronic schizophrenia were taking daily antipsychotic medication at doses exceeding an average of 1000 mg chlorpromazine equivalents (CPeq) per day. 15 In a study covering six East Asian countries and regions, Sim et al found that 17.9% of their sample was prescribed high doses of antipsychotics. 16 Such previous studies looking at trends in prescribing have been limited to comparisons of cross-sectional data from period to period.…”

Section: Introductionmentioning

confidence: 99%

Prescribing trends for the same patients with schizophrenia over 20 years

Yasuda

Kawamata

Sasaki

et al. 2022

Preprint

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BACKGROUND: Recent pharmacoepidemiology data show an increase in the proportion of patients receiving second-generation antipsychotic (SGA) monotherapy, but no studies have analyzed the same patients over a long period of time. Therefore, in this study, we decided to evaluate retrospectively schizophrenia patients with available data for 20 years to see whether the drug treatments in the same patients have changed in the past 20 years. METHODS: The study began in April 2021 and was conducted in 15 psychiatric hospitals in Japan. Schizophrenia patients treated in the same hospital for 20 years were retrospectively examined for all prescriptions in 2016, 2011, 2006, and 2001 (i.e., every 5 years). RESULTS: The mean age of the 716 patients surveyed in 2021 was 61.7 years, with 49.0% being female. The rate of antipsychotic monotherapy use showed a slight increasing trend over the past 20 years; the rate of SGA use showed a marked increasing trend from 28.9% to 70.3% over the past 20 years, while the rate of SGA monotherapy use showed a gradual increasing trend over the past 20 years. The rates of concomitant use of anticholinergics, antidepressants, anxiolytics/sleep medications, and mood stabilizers showed decreasing, flat, decreasing, and flat trends over the past 20 years, respectively. CONCLUSION: The results of this study showed a slow but steady substitution of SGAs for first-generation antipsychotics (FGAs) over time, even in the same patients.

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Association between the examination rate of treatment‐resistant schizophrenia and the clozapine prescription rate in a nationwide dissemination and implementation study

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 17 publications

References 19 publications

Clozapine Treatment Is Associated With Higher Prescription Rate of Antipsychotic Monotherapy and Lower Prescription Rate of Other Concomitant Psychotropics: A Real-World Nationwide Study

Clozapine Treatment Is Associated With Higher Prescription Rate of Antipsychotic Monotherapy and Lower Prescription Rate of Other Concomitant Psychotropics: A Real-World Nationwide Study

Prescription of Anticholinergic Drugs in Patients With Schizophrenia: Analysis of Antipsychotic Prescription Patterns and Hospital Characteristics

Prescribing trends for the same patients with schizophrenia over 20 years

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