Choice of randomization to clozapine versus other second generation antipsychotics in the CATIE schizophrenia trial

Abstract

There is evidence to suggest that clozapine is underutilized in treatment-refractory schizophrenia. Data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE), a multi-phase, randomized comparative effectiveness trial for schizophrenia, were used to identify factors associated with choosing randomization to clozapine. Two pathways were available in phase 2 of CATIE: randomization to clozapine or an untried atypical antipsychotic (2E), or randomization to an untried atypical antipsychotic (2T). We examined the proportion of entrants who chose to enter phase 2E due to the lack of efficacy of the phase 1 treatment, along with their demographic and clinical characteristics. Only 31.2% who discontinued phase 1 for lack of efficacy entered phase 2E. In multivariable analysis, males showed significantly increased odds of choosing phase 2E (adjusted odds ratio (AOR) = 2.38; confidence interval (CI) = 1.20, 4.70) as did patients with higher Positive and Negative Syndrome Scale total scores (AOR = 1.01; CI = 1.00, 1.03), more inpatient days (AOR = 1.06; CI = 1.02, 1.10) and more outpatient visits, (AOR = 1.06; CI = 1.02, 1.11). More effort examining the decision-making process of patients and providers is needed in order to increase the utilization of this effective treatment.

Clozapine: a review of clinical practice guidelines and prescribing trends

“…Concerns over other adverse effects, which include weight gain, hyperglycemia, seizures, tachycardia, myocarditis and neuromalignant syndrome [ 61 ], can affect the decision making process and even less severe side effects (sedation, constipation, nocturnal hypersalivation) might result in patients’ resistance to try this medication [ 42 , 62 ]. Clozapine has shown, however, a definite advantage in reversing tardive dyskinesia [ 13 , 17 , 34 , 58 ].…”

Clozapine prescribing in the UK: views and experience of consultant psychiatrists

“…Psychiatrists pointed out about the importance of patient choice and the need for self-determination. However, this has been challenged given the effect of TRS on the patient outcomes and service utilization [Patel, 2012; Hermes and Rosenheck, 2012]. Conservative estimates indicate that TRS adds more than US$34 billion in annual direct medical costs in the USA [Kennedy et al 2013].…”

A Case of Drug-Induced Acute Dyskinesia Treated with Korean Medicine

“…Concerns over other adverse effects, which include weight gain, hyperglycemia, seizures, tachycardia, myocarditis and neuromalignant syndrome [61], can affect the decision making process and even less severe side effects (sedation, constipation, nocturnal hypersalivation) might result in patients' resistance to try this medication [42,62]. Clozapine has shown, however, a definite advantage in reversing tardive dyskinesia [13,17,34,58].…”