Clozapine : les dernières recommandations de la FDA et nous…

Mouaffak, Fayçal; Foulon, Stéphanie; Smail, Fadhéla; Willoquet, Gérard

doi:10.1016/j.encep.2016.08.003

Cited by 3 publications

(1 citation statement)

References 8 publications

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“…, 2016 ), a rate steadily declining since 2014 (Warnez and Alessi-Severini, 2014 ), and to be 3% in France (Mouaffak et al. , 2016 ). Additionally, the rate of antipsychotic polypharmacy (APP) has reached up to 40% (Cotes et al.…”

Section: Introductionmentioning

confidence: 99%

Characterization of antipsychotic utilization before clozapine initiation for individuals with schizophrenia: an innovative visualization of trajectories using French National Health Insurance data

Laforgue,

Istvan,

Chaslerie

et al. 2023

Epidemiol Psychiatr Sci

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Aims Despite recommendations to initiate clozapine after two unsuccessful trials of antipsychotics, clozapine is underprescribed and initiated too late. The aim of this study was to describe different antipsychotic treatment sequences in the 36 months before the initiation of clozapine and to characterize clusters of treatment trajectories. Methods Using the French National Health Insurance database, a historical cohort study of the population in an area in western France was performed. The data from all new users of clozapine with a diagnosis of schizophrenia or schizoaffective disorder in the period of 2017–2018 were evaluated. All outpatient reimbursements for antipsychotics during the 36 months before clozapine initiation were analysed. Successive reimbursements for identical treatments were grouped into treatment trials (TTs), and different trajectories were clustered using a state sequence analysis. Results The results showed 1191 TTs for 287 individuals. The mean number of TTs per individual was 3.2. Risperidone, aripiprazole and haloperidol were the main treatments delivered. The frequencies of antipsychotics used differed between monotherapies and combination therapies. A three-cluster typology was identified: one cluster (n = 133) of ‘less treated’ younger individuals with fewer TTs and shorter TT durations; a second cluster (n = 53) of ‘more treated’ individuals with higher numbers of TTs and combinations of antipsychotics; and a third cluster (n = 103) of ‘treatment-stable’ older individuals with longer TT durations. Conclusions The results indicate that the median number of TTs during the 36 months before clozapine prescription was higher than the two recommended. The different trajectories were associated with individual characteristics and treatment differences, suggesting that additional studies of clinical parameters are needed to understand barriers to clozapine prescription.

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Section: Introductionmentioning

confidence: 99%

Characterization of antipsychotic utilization before clozapine initiation for individuals with schizophrenia: an innovative visualization of trajectories using French National Health Insurance data

Laforgue,

Istvan,

Chaslerie

et al. 2023

Epidemiol Psychiatr Sci

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What about regular hematological monitoring during clozapine treatment? A compliance analysis using the French health insurance database

Laforgue

Istvan

Guerlais

et al. 2021

Expert Opinion on Drug Safety

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Safety of antipsychotics for the treatment of schizophrenia: a focus on the adverse effects of clozapine

Berardis¹,

Rapini²,

Olivieri³

et al. 2018

Therapeutic Advances in Drug Safety

156

125

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Clozapine, a dibenzodiazepine developed in 1961, is a multireceptorial atypical antipsychotic approved for the treatment of resistant schizophrenia. Since its introduction, it has remained the drug of choice in treatment-resistant schizophrenia, despite a wide range of adverse effects, as it is a very effective drug in everyday clinical practice. However, clozapine is not considered as a top-of-the-line treatment because it may often be difficult for some patients to tolerate as some adverse effects can be particularly bothersome (i.e. sedation, weight gain, sialorrhea etc.) and it has some other potentially dangerous and life-threatening side effects (i.e. myocarditis, seizures, agranulocytosis or granulocytopenia, gastrointestinal hypomotility etc.). As poor treatment adherence in patients with resistant schizophrenia may increase the risk of a psychotic relapse, which may further lead to impaired social and cognitive functioning, psychiatric hospitalizations and increased treatment costs, clozapine adverse effects are a common reason for discontinuing this medication. Therefore, every effort should be made to monitor and minimize these adverse effects in order to improve their early detection and management. The aim of this paper is to briefly summarize and provide an update on major clozapine adverse effects, especially focusing on those that are severe and potentially life threatening, even if most of the latter are relatively uncommon.

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Clozapine : les dernières recommandations de la FDA et nous…

Cited by 3 publications

References 8 publications

Characterization of antipsychotic utilization before clozapine initiation for individuals with schizophrenia: an innovative visualization of trajectories using French National Health Insurance data

Characterization of antipsychotic utilization before clozapine initiation for individuals with schizophrenia: an innovative visualization of trajectories using French National Health Insurance data

What about regular hematological monitoring during clozapine treatment? A compliance analysis using the French health insurance database

Safety of antipsychotics for the treatment of schizophrenia: a focus on the adverse effects of clozapine

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