Clozapine Induced Myocarditis: A Potentially Silent and Fatal Threat

Lebrun, Sandrine; Dougherty, Renee; Mazurkiewicz, Rebecca

doi:10.1016/s0735-1097(18)32979-6

Cited by 2 publications

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“…Afterward, 16 of them were excluded because they were classified as possible (n = 13, 30.2%) or no case (n = 3, 7%). A reference list for papers classified as no cases or possible is included in the Supplementary (Belloni et al, 2007;Benning, 1998;Bugge et al, 2016;Fehily et al, 2016;Lebrun et al, 2018;Lim et al, 2003;Masopust et al, 2009;Merrill et al, 2006;Mohan et al, 2013;Mukherjee et al, 2019;Pelizza and Melegari, 2007;Rhee et al, 2019;Sanader et al, 2019;Trincas et al, 2017) (S4 Reference list). Lastly, 27 patients reported in 26 publications scored as probable (n = 23, 53.5%) or definite DRESS (n = 4, 9.3%) were included in the review (Figure 1).…”

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confidence: 99%

Unravelling cases of clozapine-related Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) in patients reported otherwise: A systematic review

et al. 2021

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Background: The drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a drug-induced hypersensitivity reaction. Aims: Aim was to review reports of clozapine-related reactions fulfilling the registry of severe cutaneous adverse reaction (RegiSCAR) criteria for DRESS syndrome reported as such or otherwise, to provide a descriptive overview of demographic patterns, clinical manifestations, and DRESS course and investigate associations between demographic, DRESS parameters, and clinical outcomes. Methods: This review was conducted following preferred reporting items for systematic reviews and meta-analyses guidelines and registered with PROSPERO (registration number CRD42020156385). We searched PubMed/Embase/PsychInfo/Cochrane for reports of clozapine-related reactions meeting RegiSCAR criteria. Associations between RegiSCAR scores and time-to-recovery with demographic/clinical variables were assessed. Demographic/clinical characteristics of patients with versus without reported DRESS were compared using non-parametrical tests. Results: We identified 26 reports of 27 patients meeting RegiSCAR criteria. Males ( n = 19, 70.4%) and patients with schizophrenia ( n = 18, 66.7%) were mainly affected. Twelve patients (44.4%) received clozapine-monotherapy. DRESS symptoms manifested within a month after clozapine initiation ( n = 24, 88.9%). Lungs and liver were the most common organs involved ( n = 12, 44.4%; n = 11, 40.7%), with a mean time to recovery of 33.75 days. Clozapine rechallenge led to DRESS recurrence in four patients. Death rate was 7.4%. No associations were detected between RegiSCAR criteria or days to recovery with any demographic/clinical variables. No differences between patients with versus without reported DRESS were detected. Conclusions: Clozapine-related DRESS may be rare, but also underreported. Clinicians need to be aware of it even in patients under clozapine-monotherapy or without skin rash.

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