Current use of second-generation antipsychotics may increase risk of pneumonia in people with schizophrenia

Haddad, Peter M.

doi:10.1136/eb-2013-101441

Cited by 8 publications

(2 citation statements)

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“… 12 However, there appears to be an additional effect of clozapine treatment. 13 – 16 In the study of Kuo and colleagues, treatment with clozapine was associated with approximately a doubling of the risk of pneumonia. 14 However, confounding by indication could have affected these results: clozapine is prescribed to people with treatment-resistant schizophrenia, and such individuals are likely to have a range of comorbidities that increase the risk of infection, such as smoking and other substance misuse, poor diet and a sedentary lifestyle.…”

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confidence: 99%

Clozapine treatment and risk of COVID-19 infection: retrospective cohort study

et al. 2020

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Background Clozapine, an antipsychotic with unique efficacy in treatment-resistant psychosis, is associated with increased susceptibility to infection, including pneumonia. Aims To investigate associations between clozapine treatment and increased risk of COVID-19 infection in patients with schizophrenia-spectrum disorders who are receiving antipsychotic medications in a geographically defined population in London, UK. Method Using information from South London and Maudsley NHS Foundation Trust (SLAM) clinical records, via the Clinical Record Interactive Search system, we identified 6309 individuals who had an ICD-10 diagnosis of schizophrenia-spectrum disorders and were taking antipsychotics at the time of the COVID-19 pandemic onset in the UK. People who were on clozapine treatment were compared with those on any other antipsychotic treatment for risk of contracting COVID-19 between 1 March and 18 May 2020. We tested associations between clozapine treatment and COVID-19 infection, adjusting for gender, age, ethnicity, body mass index (BMI), smoking status and SLAM service use. Results Of 6309 participants, 102 tested positive for COVID-19. Individuals who were on clozapine had increased risk of COVID-19 infection compared with those who were on other antipsychotic medication (unadjusted hazard ratio HR = 2.62, 95% CI 1.73–3.96), which was attenuated after adjusting for potential confounders, including clinical contact (adjusted HR = 1.76, 95% CI 1.14–2.72). Conclusions These findings provide support for the hypothesis that clozapine treatment is associated with an increased risk of COVID-19 infection. Further research will be needed in other samples to confirm this association. Potential clinical implications are discussed.

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Clozapine treatment and risk of COVID-19 infection: retrospective cohort study

et al. 2020

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“…Patients receiving clozapine treatment have lower rates of overall hospitalisation and mortality compared to those receiving other antipsychotic treatments ( Hayes et al , 2015 ; Wimberley et al , 2017 ; Cho et al , 2018 ; Kesserwani et al , 2019 ). However, clozapine is associated with an increased risk of developing pneumonia ( Haddad, 2013 ; Kuo et al , 2013 ; Stoecker et al , 2017 ; De Leon, Sanz and De las Cuevas, 2020 ). This might be explained by confounding by indication, in that clozapine is predominantly prescribed in cases of treatment-resistant schizophrenia, associated in itself with higher rates of comorbidities such as smoking cigarettes, inadequate physical activity, and poor diet ( Liu et al , 2017 ).…”

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confidence: 99%

COVID-related hospitalization, intensive care treatment, and all-cause mortality in patients with psychosis and treated with clozapine

Ware

Freitas

Pritchard

et al. 2022

European Neuropsychopharmacology

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Clozapine, an antipsychotic, is associated with increased susceptibility to infection with COVID-19, compared to other antipsychotics. Here, we investigate associations between clozapine treatment and increased risk of adverse outcomes of COVID-19, namely COVID-related hospitalisation, intensive care treatment, and death, among patients taking antipsychotics with schizophrenia-spectrum disorders. Using the clinical records of South London and Maudsley NHS Foundation Trust, we identified 157 individuals who had an ICD-10 diagnosis of schizophrenia-spectrum disorders, were taking antipsychotics (clozapine or other antipsychotics) at the time of COVID-19 pandemic in the UK and had a laboratory-confirmed COVID-19 infection. The following health outcomes were measured: COVID-related hospitalisation, COVID-related intensive care treatment and death. We tested associations between clozapine treatment and each outcome using logistic regression models, adjusting for gender, age, ethnicity, neighbourhood deprivation, obesity, smoking status, diabetes, asthma, bronchitis and hypertension using propensity scores. Of the 157 individuals who developed COVID-19 while on antipsychotics (clozapine or other antipsychotics), there were 28% COVID-related hospitalisations, 8% COVID-related intensive care treatments and 8% deaths of any cause during the 28 days follow-up period. Among those taking clozapine, there were 25% COVID-related hospitalisations, 7% COVID-related intensive care treatments and 7% deaths. In both unadjusted and adjusted analyses, we found no significant association between clozapine and any of the outcomes. Thus, we found no evidence that patients with clozapine treatment at time of COVID-19 infection had increased risk of hospitalisation, intensive care treatment or death, compared to non-clozapine antipsychotic-treated patients. However, further research should be considered in larger samples to confirm this. schizophrenia clozapine Antipsychotic agents COVID-19 SARS-CoV-2

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Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder

et al. 2015

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People with severe mental illness have a considerably shorter lifespan than the general population. This excess mortality is mainly due to physical illness. Next to mental illness-related factors, unhealthy lifestyle, and disparities in health care access and utilization, psychotropic medications can contribute to the risk of physical morbidity and mortality. We systematically reviewed the effects of antipsychotics, antidepressants and mood stabilizers on physical health outcomes in people with schizophrenia, depression and bipolar disorder. Updating and expanding our prior systematic review published in this journal, we searched MEDLINE (November 2009 -November 2014, combining the MeSH terms of major physical disease categories (and/or relevant diseases within these categories) with schizophrenia, major depressive disorder and bipolar disorder, and the three major psychotropic classes which received regulatory approval for these disorders, i.e., antipsychotics, antidepressants and mood stabilizers. We gave precedence to results from (systematic) reviews and meta-analyses wherever possible. Antipsychotics, and to a more restricted degree antidepressants and mood stabilizers, are associated with an increased risk for several physical diseases, including obesity, dyslipidemia, diabetes mellitus, thyroid disorders, hyponatremia; cardiovascular, respiratory tract, gastrointestinal, haematological, musculoskeletal and renal diseases, as well as movement and seizure disorders. Higher dosages, polypharmacy, and treatment of vulnerable (e.g., old or young) individuals are associated with greater absolute (elderly) and relative (youth) risk for most of these physical diseases. To what degree medication-specific and patient-specific risk factors interact, and how adverse outcomes can be minimized, allowing patients to derive maximum benefits from these medications, requires adequate clinical attention and further research.

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Current use of second-generation antipsychotics may increase risk of pneumonia in people with schizophrenia

Cited by 8 publications

References 1 publication

Clozapine treatment and risk of COVID-19 infection: retrospective cohort study

Clozapine treatment and risk of COVID-19 infection: retrospective cohort study

COVID-related hospitalization, intensive care treatment, and all-cause mortality in patients with psychosis and treated with clozapine

Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder

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