Outcome Following Clozapine Discontinuation

Atkinson, James; Douglas-Hall, Petrina; Fischetti, Catrin; Sparshatt, Anna; Taylor, David

doi:10.4088/jcp.v68n0708

Cited by 40 publications

(48 citation statements)

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“…However, a retrospective analysis indicated that death was a common cause of ceasing clozapine treatment. 1 In another study that investigated the reasons for discontinuing clozapine, pneumonia was the primary cause of death in about 24% of patients.…”

Section: Myoclonus As An Indicator Of Infection In Patients With Schimentioning

confidence: 99%

Myoclonus as an indicator of infection in patients with schizophrenia treated with clozapine

Liang

2011

J Psychiatry Neurosci

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Section: Myoclonus As An Indicator Of Infection In Patients With Schimentioning

confidence: 99%

Myoclonus as an indicator of infection in patients with schizophrenia treated with clozapine

Liang

2011

J Psychiatry Neurosci

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“…It is also important to note the small sample size for the group switched to alternative treatment by T4 (n = 28), which limits the comparisons between the clozapine and non-clozapine treatment groups and the findings need to be viewed with this in mind. In the other published study, we found of outcome after clozapine discontinuation, higher rates of antipsychotic polypharmacy were reported; 43.5% who continued to be prescribed antipsychotics after clozapine discontinuation were treated with two or more concurrently (Atkinson, et al, 2007). Atkinson, et al also found that clinical outcome (assessed by Global Assessment of Functioning) was worse in the year after discontinuation compared with the year on clozapine, but they found no difference in hospitalisation before and after discontinuation.…”

Section: Discussionmentioning

confidence: 61%

Outcomes for schizophrenia patients with clozapine treatment: how good does it get?

2008

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The objective of this study was to describe the extent/change (2000-2004) of clozapine prescribing in schizophrenia in New Zealand and examine the outcomes associated with increasing treatment duration, and vs. those who discontinue clozapine. Consecutive chart reviews were conducted for adult outpatients in Auckland/Northland regions (T1 = 31 March 2000, T2 = 31 October 2001, T3 = 31 March 2003, T4 = 31 October 2004). Data collected included: patient characteristics, social/functional indicators, diagnosis, duration of illness, psychiatric admissions and treatment information (psychotropic medication, dose, route of administration). Between 2000 and 2004, clozapine for schizophrenia increased from 21.0% to 32.8%. Of those prescribed clozapine at T1, 86.1% were engaged with community services at T4 and 93.2% still prescribed clozapine. Continuing clozapine treatment (vs. other treatment) led to a trend to higher rates of regular occupational activity (37% vs. 14.3%) and lower rates of compulsory treatment (25.1% vs. 46.4%) and significantly lower hospitalisation rates (mean = 0.6 vs. mean = 3.1). For those prescribed clozapine at T4, increasing treatment duration (< or = 10 months, 2-3 years, >3 years) led to a trend to higher rates of living independently (18% vs. 29.2% vs. 34%) and regular occupational activity (26.2% vs. 32.6% vs. 37.5%), and significantly reduced compulsory treatment (44.3% vs. 36.9% vs. 28.6%) and hospitalisation rates in the previous 18 months (1.5 vs. 0.5 vs. 0.2). Clozapine use increased significantly over 4.5 years to expected rates of treatment-resistant schizophrenia. Low clozapine discontinuation rates were found and continuing treatment was associated with real-world improvements in functional and clinical outcomes. These findings support the recommendation of prolonged clozapine trials to improve cost-effectiveness in the most seriously unwell schizophrenia patients.

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“…Reported proportions of patients on clozapine having seizures range from 1.1% to 20%,36–39) and associated fatalities have been reported 9,40). Convulsions are dose related,33) and higher plasma clozapine concentrations have been linked to an increased risk of seizures 41).…”

Section: Serious Adverse Effects and Fatalitiesmentioning

confidence: 99%

Clozapine Monitoring in Clinical Practice: Beyond the Mandatory Requirement

Kar

Barreto

Chandavarkar

2016

Clin Psychopharmacol Neurosci

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Clozapine is effective in treatment resistant schizophrenia; however, it is underutilised probably because of its side effects. The side effects are also the potential reasons for clozapine discontinuation. A mandatory requirement for its use is regular monitoring of white blood cell count and absolute neutrophil count. However there are many side effects that need monitoring in clinical practice considering their seriousness. This article tries to summarise the clinical concerns surrounding the serious side effects of clozapine some of which are associated with fatalities and presents a comprehensive way to monitor patients on clozapine in clinical practice. It emphasizes the need to broaden the monitoring beyond the mandatory investigations. This may help in improving the safety in clinical practice and increasing clinician confidence for greater and appropriate use of this effective intervention.

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Outcome Following Clozapine Discontinuation

Cited by 40 publications

References 0 publications

Myoclonus as an indicator of infection in patients with schizophrenia treated with clozapine

Myoclonus as an indicator of infection in patients with schizophrenia treated with clozapine

Outcomes for schizophrenia patients with clozapine treatment: how good does it get?

Clozapine Monitoring in Clinical Practice: Beyond the Mandatory Requirement

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