Haematological side effects associated with clozapine: A retrospective study from India

Grover, Sandeep; Shouan, Anish; Chakrabarti, Subho

doi:10.1016/j.ajp.2019.101906

Cited by 23 publications

(17 citation statements)

References 45 publications

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“…More recently, a retrospective study described hematological side effects in a 303 patients from India during a 49-month period. About one-fifth of the total cohort (64 individuals) developed hematological anomalies, but no neutrophilia case was described, in contrast with previous reports [ 41 ]. Further research is needed to clarify the possible contribution of ethnic factors in the observed incidence of blood dyscrasia.…”

Section: Discussioncontrasting

confidence: 80%

Leukocytosis Associated with Clozapine Treatment: A Case Series and Systematic Review of the Literature

et al. 2021

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Background and Objectives: Clozapine is the only antipsychotic approved for treatment-resistant schizophrenia. Despite its superior efficacy profile as compared with other antipsychotics, clozapine remains underutilized. Clozapine monitoring systems clearly describe the proposed management of clozapine-induced neutropenia; however, no specific mention is made of how to interpret neutrophilic leukocytosis, despite that being a relatively frequent finding. Prescribers unfamiliar with this molecule may misjudge its clinical significance, potentially leading to untimely treatment interruption. Here, we systematically review the literature on the risk of neutrophilic leukocytosis during clozapine treatment, and describe eight additional cases among our patient cohort. Materials and Methods: We performed a systematic review of the literature on PubMed and Embase using the PRISMA 2020 guidelines, and selected all original reports describing either (1) the prevalence of neutrophilic leukocytosis during clozapine treatment, or (2) the clinical significance of neutrophilic leukocytosis. We described eight additional cases of neutrophilic leukocytosis during clozapine treatment while attending an outpatient psychiatric clinic. Results: Our research ultimately yielded the selection of 13 articles included in this systematic review. The case series highlighted the presence of stable and clinically unremarkable neutrophilia during a follow-up ranging from one to ten years. Conclusions: Existing evidence indicates that leukocytosis associated with clozapine treatment can be considered as an asymptomatic and benign condition, suggesting that no change in clozapine treatment is needed upon its detection.

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Section: Discussioncontrasting

confidence: 80%

Leukocytosis Associated with Clozapine Treatment: A Case Series and Systematic Review of the Literature

et al. 2021

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“…The largest study with 2,404 patients in Italy found an incidence of 2.2% based on the criteria of an eosinophil count greater than 400 cells/mm 3 7 . The most recent studies reported that approximately one‐tenth (N = 33; 9.9%) of patients developed eosinophilia (absolute eosinophil count >600 cells/mm 3 ) 8 . In addition, cases of pancreatitis, hepatitis, colitis, nephritis, and myocarditis‐associated eosinophilia have been reported 9 .…”

Section: Discussionmentioning

confidence: 99%

“…7 The most recent studies reported that approximately onetenth (N = 33; 9.9%) of patients developed eosinophilia (absolute eosinophil count >600 cells/mm 3 ). 8 In addition, cases of pancreatitis, hepatitis, colitis, nephritis, and myocarditis-associated eosinophilia have been reported. 9 Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) is an uncommon side effect of certain medications.…”

Section: F I G U R Ementioning

confidence: 99%

Clozapine‐associated severe eosinophilia following lithium rebound neutropenia: A case report

Kikuchi

Yasui‐Furukori

Yokoyama

et al. 2020

Neuropsychopharm Rep

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A recent network meta-analysis suggested that clozapine is superior to other antipsychotics, 1 and several guidelines regarding pharmacotherapy for schizophrenia recommend clozapine as the best choice for treatment-resistant schizophrenia. 2,3 However, its use is complicated by an increased risk of hematological adverse effects such as neutropenia 4 and, rarely, eosinophilia. 5 Eosinophilia develops as an immunologically mediated response in association with diverse processes, including allergic, neoplastic, and infectious diseases. 6 We present the case of a 48-year-old man with treatment-resistant schizophrenia and clozapine-associated severe eosinophilia and then neutropenia secondary to lithium discontinuation. Written consent for publication of the case report was provided by the patient.

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“…14,[24][25][26] The only other Indian study reported a rate of 0.6% for neutropenia. 26 This study adds to the very limited data in this area from India.…”

Section: Clozapine and Seizuresmentioning

confidence: 99%

“…23 Rates of agranulocytosis and neutropenia in this sample were well within the range of reported data. 14,[24][25][26] The only other Indian study reported a rate of 0.6% for neutropenia. 26 This study adds to the very limited data in this area from India.…”

Section: Clozapine and Seizuresmentioning

confidence: 99%

De Novo Seizures, Obsessive Compulsive Symptoms and Neutropenias in Patients on Clozapine: A Retrospective Cohort Study

Chichra

Varughese

Innamuri

2022

Indian Journal of Psychological Medicine

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Background: Clozapine has well-documented inter-ethnic variations in pharmacokinetics. There is a paucity of data about clozapine use and associated adverse events such as seizures, obsessive compulsive symptoms, neutropenia, and agranulocytosis, from India. Methods: This retrospective cohort study followed up 228 patients initiated on clozapine in a tertiary care referral center in India for an average of 10 years. We calculated incidence rates of new-onset seizures, new-onset obsessive compulsive symptoms, agranulocytosis, and neutropenia. We collected data on doses of clozapine used and serum assays and calculated concentration-to-dose (C/D) ratios. We also collected relevant clinical details about clozapine-induced seizures. Results: In the sample, 16.8% had new-onset seizures, 12.3% had new-onset OC symptoms, 2.7% had neutropenia, and 0.9% had agranulocytosis. The mean C/D ratio was 2.09 (SD = 1.8). Almost half (46.3%) of available serum assays were in the supra-therapeutic range. Seizures were associated with a higher clozapine dose at one year (OR = 1.003; 95%CI = 1.000–1.006; P value = 0.045) and the presence of positive psychotic symptoms at one year (OR = 4.214; 95%CI = 1.894–9.373; P < 0.001). Conclusion: Compared to existing literature, Indians have a higher rate of clozapine- related seizures and need lower doses to reach therapeutic serum levels.

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Haematological side effects associated with clozapine: A retrospective study from India

Cited by 23 publications

References 45 publications

Leukocytosis Associated with Clozapine Treatment: A Case Series and Systematic Review of the Literature

Leukocytosis Associated with Clozapine Treatment: A Case Series and Systematic Review of the Literature

Clozapine‐associated severe eosinophilia following lithium rebound neutropenia: A case report

De Novo Seizures, Obsessive Compulsive Symptoms and Neutropenias in Patients on Clozapine: A Retrospective Cohort Study

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