Factors associated with changes in hospitalisation in patients prescribed clozapine

Gee, Siobhan; Shergill, Sukhwinder S.; Taylor, David

doi:10.1177/0269881116642745

Cited by 14 publications

(14 citation statements)

References 34 publications

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“…For example, evidence has been mainly derived from medical health insurance records, with findings indicating that the choice between APP or monotherapy has no effect on the risk for readmission (Boaz et al 2013 ); and that APP is associated with lower hospital readmission in comparison to monotherapy (Katona et al 2014 ). There has been sparse evidence to suggest that clozapine is associated with reduced rehospitalisation (Nielsen et al 2012 ; Gee et al 2016 ; Tiihonen et al 2017 ), and clozapine augmentation is currently the only APP regime that has some empirical support (Freudenreich and Goff 2002 ; Taylor et al 2011 ), hence its acceptance as a third-line treatment for SMI (NCCMH 2010 ). However, it is unclear whether people receiving clozapine polypharmacy differ in the risk of readmission.…”

Section: Introductionmentioning

confidence: 99%

Antipsychotic polypharmacy prescribing and risk of hospital readmission

et al. 2017

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ObjectivesThe aim of this study was to determine if there was an association between being discharged on antipsychotic polypharmacy (APP) and risk of readmission into secondary mental health care.MethodsUsing data from the South London and Maudsley (SLAM) case register, service users with serious mental illness (SMI), discharged between 1st January 2007 and 31th December 2014, were followed up for 6 months. Patients were classified as receiving either monotherapy or polypharmacy at index discharge. Multivariable Cox regression models were constructed, adjusting for sociodemographic, socioeconomic, clinical and service use factors.ResultsWe identified 5523 adults who had been admitted at least once to SLAM, of whom 1355 (24.5%) were readmitted into secondary mental health care. In total, 15% (n = 826) of patients were discharged on APP and 85% (n = 4697) on monotherapy. Of these, 30.9% (n = 255) and 23.4% (n = 1100) were readmitted respectively. Being discharged on APP was associated with a significantly increased risk of readmission, in comparison to patients discharged on monotherapy (HR = 1.4, 1.2–1.7, p < 0.001). This association was maintained in the fully adjusted model and following several sensitivity analyses. We further established that patients receiving clozapine APP (n = 200) were at a significantly increased risk for readmission in comparison to patients on clozapine monotherapy (HR = 1.8, 1.2–2.6, p = 0.008).ConclusionsOur results suggest that patients discharged on APP are more likely to be readmitted into hospital within 6 months in comparison to those discharged on monotherapy. This needs to be considered in treatment decisions and the reasons for the association clarified.

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Section: Introductionmentioning

confidence: 99%

Antipsychotic polypharmacy prescribing and risk of hospital readmission

et al. 2017

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“…Naturalistic observations of outcomes in clinical practice strongly support the superiority of clozapine over other antipsychotics in terms of continuation with treatment [18], relapse [19], hospitalisations [20,21] and even mortality [22]. Clozapine may be the only antipsychotic with which relapse occurs only after periods of non-ingestion and never during full compliance [23].…”

Section: ó Springer International Publishing Switzerland 2017mentioning

confidence: 97%

Clozapine for Treatment-Resistant Schizophrenia: Still the Gold Standard?

Taylor

2017

CNS Drugs

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“…If duration of illness is associated with degree of antipsychotic response, then it is reasonable to hypothesize that if clozapine is used earlier in TRS, it may be even more effective compared to other antipsychotic medication than when given later in the illness course. There is some research to suggest that starting clozapine early in the course of TRS is beneficial compared to delaying clozapine [32][33][34][35][36][37]. However, these findings are confined to retrospective data and do not assess the relative effectiveness of clozapine compared to alternative antipsychotics at different stages of illness.…”

Section: Introductionmentioning

confidence: 99%

Effect of age on the relative efficacy of clozapine in schizophrenia

Jones

MacCabe

Price

et al. 2020

Acta Psychiatr Scand

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Objective: Early treatment of schizophrenia improves outcomes. Clozapine appears to have unique benefit when other antipsychotic medication has failed. This systematic review and meta-analysis aims to assess clozapine's superiority over alternative antipsychotic medication and examine whether earlier use is associated with additional benefit. Method: Systematic retrieval of blinded, randomized controlled trials comparing clozapine with alternative antipsychotics in adults with schizophrenia. The effect of mean age on relative clozapine response was examined using random effects meta-regression, and multiple linear regression on available patient data. Results: A total of 276 studies were retrieved. Thirty-four studies were included in the meta-analysis. Clozapine was significantly more effective than alternative antipsychotics in reducing psychotic symptoms and increasing response. However, meta-regression failed to show a more significant effect in younger patients (age on effect size (total psychotic symptoms) 0.00, P = 0.79 CI À0.03 to 0.03). Individual patient data were available for two studies, the larger of which showed a significant interaction between younger age and superiority of clozapine. Conclusion: The results support clozapine's superiority over other antipsychotics. A convincing effect of age on this effect was not demonstrated, although this was suggested in one study. In view of the age of many of the included studies, and changes in reporting practice over time, new clozapine RCTs, which include age of illness onset as well as age at trial time, would be welcome in order to provide metaanalysable data for future use.

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Factors associated with changes in hospitalisation in patients prescribed clozapine

Cited by 14 publications

References 34 publications

Antipsychotic polypharmacy prescribing and risk of hospital readmission

Antipsychotic polypharmacy prescribing and risk of hospital readmission

Clozapine for Treatment-Resistant Schizophrenia: Still the Gold Standard?

Effect of age on the relative efficacy of clozapine in schizophrenia

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