Continuing clozapine with granulocyte colony-stimulating factor in patients with neutropenia

Khan, Al Aditya; Harvey, Jake; Sengupta, Samrat

doi:10.1177/2045125313476877

Cited by 21 publications

(13 citation statements)

References 28 publications

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“…Of the articles identified, the majority were case reports with the other article types consisting of five case series (Hagg et al, 2003;Joffe et al, 2009;Khan et al, 2013;Mathewson and Lindenmayer, 2007;Sengupta and Harvey, 2010) and one cohort study where individual cases were reported (Meyer et al, 2015). The majority of cases were male (82%), Caucasian (67%) and young (median age 34 years, range 17-63).…”

Section: Resultsmentioning

confidence: 99%

“…The absence of specific side effects attributable to G-CSF was reported in 15 cases. Most adverse outcomes were related to recurrent neutropenia with an episode of severe sepsis due to tonsillitis reported in one case (Joffe et al, 2009), pneumonia reported in another case (Khan et al, 2013) and complicated urinary tract infection in another (Majczenko and Stewart, 2008). Mild euphoria was reported in one case (Broughton et al, 2012) shortly after each weekly dose of lenograstim 105 µg.…”

Section: Safety Outcomesmentioning

confidence: 99%

See 1 more Smart Citation

Use of granulocyte-colony stimulating factor to prevent recurrent clozapine-induced neutropenia on drug rechallenge: A systematic review of the literature and clinical recommendations

Myles

Clark

Bird

et al. 2017

Aust N Z J Psychiatry

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Background: Clozapine is the most effective medication for treatment-refractory schizophrenia; however, its use is contraindicated in people who have had previous clozapine-induced neutropenia. Co-prescription of granulocyte-colony stimulating factor may prevent recurrent neutropenia and allow continuation or rechallenge of clozapine.Objective and methods: Systematic review of literature reporting the use of granulocyte-colony stimulating factor to allow rechallenge or continuation of clozapine in people with previous episodes of clozapine-induced neutropenia. The efficacy of granulocyte-colony stimulating factor and predictors of successful rechallenge will be determined to elucidate whether evidence-based recommendations can be made regarding the use of granulocyte-colony stimulating factor in this context. Results:A total of 17 articles were identified that reported on clozapine rechallenge with granulocyte-colony stimulating factor support. In all, 76% of cases were able to continue clozapine at median follow-up of 12 months. There were no clear clinical or laboratory predictors of successful rechallenge; however, initial neutropenia was more severe in successful cases compared to unsuccessful cases. Cases co-prescribed lithium had lower success rates of rechallenge (60%) compared to those who were not prescribed lithium (81%). The most commonly reported rechallenge strategy was use of filgrastim 150-480 µg between daily to three times a week. There were no medication-specific side effects of granulocyte-colony stimulating factor reported apart from euphoria in one case. Three cases who failed granulocytecolony stimulating factor had bacterial infection at time of recurrent neutropenia. No deaths were reported. Conclusion:Preliminary data suggest granulocyte-colony stimulating factor is safe and effective in facilitating rechallenge with clozapine. Clinical recommendations for use are discussed.

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Section: Resultsmentioning

confidence: 99%

Section: Safety Outcomesmentioning

confidence: 99%

Use of granulocyte-colony stimulating factor to prevent recurrent clozapine-induced neutropenia on drug rechallenge: A systematic review of the literature and clinical recommendations

Myles

Clark

Bird

et al. 2017

Aust N Z J Psychiatry

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“…We identified 32 episodes(in 31 patients) of clozapine re-challenge, where G-CSF was prescribed as maintenance prophylaxis (n=23)(9-19) or as single, as required administrations (n=9) (13,14,(20)(21)(22)(23)(24) to enable continued clozapine treatment.…”

Section: Study Selection Study and Participant Characteristicsmentioning

confidence: 99%

The Use of Granulocyte Colony-Stimulating Factor in Clozapine Rechallenge

Lally¹,

Malik²,

Krivoy³

et al. 2017

J Clin Psychopharmacol

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Our findings suggest that G-CSF can sometimes be safely used to support the maintenance of normal neutrophil counts and clozapine use after neutropenia. Publication bias is an important limitation, however. Also, few reports clearly documented the presence or absence of an independent nonclozapine cause of the index neutropenia, which may have increased success rates. Furthermore, adverse events were not systematically recorded. Prospective studies are needed to determine safety because if agranulocytosis occurs on clozapine while supported by G-CSF, there is no obvious alternate rescue therapy to promote granulopoiesis. From the available data, it is not possible to recommend this course of action for someone with a true clozapine agranulocytosis.

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“…The combined use clozapine and lithium may increase the risk of neurotoxic reactions (Bender et al, 2004) while there is a paucity of data on the use of G-CSF in preventing clozapine-associated haematological adverse effects (Lally et al, 2017). Long-term G-CSF adverse effects can include enlarged spleen, hepatomegaly, urinary abnormalities and very rarely, splenic rupture (Khan et al, 2013). It could be argued that with the lowering of the threshold using the US criteria, such remedial strategies could become unnecessary in most instances.…”

Section: Discussionmentioning

confidence: 99%