Long‐term sustained benefits of clozapine treatment in refractory early onset schizophrenia: A retrospective study in Korean children and adolescents

Kim, Yeni; Kim, Boong Nyun; Cho, Soo Churl; Kim, Jae-Won; Shin, Min-Sup

doi:10.1002/hup.982

Cited by 25 publications

(29 citation statements)

References 38 publications

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“…Given the relatively small number of patients, the incidence of agranulocytosis did not appear higher than that reported in adults. Similarly, in 26 patients in Korea (mean age 14.3 ± 2.1 year) treated with clozapine for more than 1 year, although nine (27%) developed neutropenia (neutrophil count < 1.5 L −9 ), no patient developed agranulocytosis, and all were either maintained (7) on clozapine, or successfully rechallenged (2) with the drug without resort to adjunctive lithium or other measures (Kim et al ., 2008).…”

Section: Clozapine In Children and Adolescentsmentioning

confidence: 99%

Haematological toxicity of clozapine and some other drugs used in psychiatry

Nooijen

Carvalho

Flanagan

2011

Hum. Psychopharmacol. Clin. Exp.

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There remain several difficult areas, including the criteria for clozapine rechallenge. Experience has emphasised (i) the role of appropriate timing of WCC sample collection to ensure that clozapine is not withdrawn unnecessarily and (ii) the success of agents such as filgrastim in promoting rapid production of granulocytes if the situation so demands. On the other hand, the use of lithium to promote a leucocytosis has taken hold without a clear risk: benefit analysis. Be this as it may, should patients decide that they no longer wish to undergo WCC monitoring after 12 months on clozapine, cessation of monitoring is probably preferable to stopping the drug since overall mortality is decreased in patients treated with clozapine.

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Section: Clozapine In Children and Adolescentsmentioning

confidence: 99%

Haematological toxicity of clozapine and some other drugs used in psychiatry

Nooijen

Carvalho

Flanagan

2011

Hum. Psychopharmacol. Clin. Exp.

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“…Quite similarly, the age of onset in very early onset schizophrenia (VEOS), or childhood onset schizophrenia (COS) also varies across studies with definitions before 12–15 years of age [3,9,15,17,19-25]. The most common definition of EOS is onset before age 18, and the most common definition of VEOS is onset before age 13.…”

Section: Introductionmentioning

confidence: 99%

A systematic review of the long-term outcome of early onset schizophrenia

2012

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BackgroundThe current review analyzes the long-term outcome and prognosis of early onset schizophrenia based on previously published studies in 1980.MethodsA systematic search of articles published in the English-language literature after 1980 identified a total of 21 studies, which included 716 patients who were either suffering from early onset schizophrenia (EOS) or both EOS and other psychotic disorders (MIX). The authors of the current review scored the outcome as either “good,” “moderate,” or “poor.” The mean age of onset in these studies was <18 years.ResultsIn general, the outcome in studies with EOS is worse than the outcome in MIX studies. Only 15.4% of the patients in EOS studies versus 19.6% of the patients in MIX studies experienced a “good” outcome. In contrast, 24.5% of the patients in EOS studies versus 33.6% in MIX studies experienced a “moderate” outcome, and 60.1% in EOS studies versus 46.8% in MIX studies experienced a “poor” outcome. The authors identified various significant effects on outcome. In EOS, the findings were significantly affected by sample attrition, indicating that in studies with a high dropout rate, fewer patients experienced a “moderate” outcome, and more patients experienced a “poor” outcome; however, the effect sizes were small. Furthermore, the effects were also small and more favourable for specific functioning measures, as opposed to more global measures, small to moderate in terms of worse outcomes for follow-up periods >10 years, small to moderate for more unfavourable outcomes in males, and small to large for worse outcomes in studies including patients diagnosed before 1970.ConclusionsIn contrast to the adult manifestation, the early manifestation of schizophrenia in childhood and adolescence still carries a particularly poor prognosis. According to these aggregated data analyses, longer follow-up periods, male sex, and patients having been diagnosed before 1970 contribute predominantly to the rather poor course of EOS.

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“…33 In summary, the data presented here provide some support for the use of TDM-guided individualized clozapine dosage in children and adolescents in the same way as recommended for adults. 43 Of course, a limiting factor is the difficulty inherent in venepuncture in the younger age group, hence the 15 26 (12) 14.3 † (2.1) 279 (122) Not measured Fleischhaker et al 23 16 (11) 17.2 (1.8) 14-21 322 (157) Not measured Sporn et al 28 33 (22) importance of collating information from drug measurements performed for clinical purposes. Whether use of alternative specimens such as saliva or capillary blood/dried blood spots might facilitate pharmacokinetic/TDM studies in children in future remains to be ascertained.…”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14] More importantly, clinical benefit may be maintained in the long term and may translate to fewer hospitalizations and an enhanced quality of life. 15 However, clozapine is associated with serious side effects. Weight gain and metabolic abnormalities are common, and their prevalence and magnitude are said to be greater in young people than in adults, [16][17][18][19] although hyperprolactinaemia and weight gain in young people may be less with clozapine than with olanzapine.…”

Section: Introductionmentioning

confidence: 99%