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

Abstract

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.

A systematic review of clozapine induced cardiomyopathy

“…Clozapine induced cardiomyopathy does not appear to be dose dependent [9]. In this review, the range of doses for patients with reported cardiomyopathy was 125 mg-700 mg, with a mean dose of 360 mg.…”

“…Clozapine also has been shown to reduce aggression more effectively than other antipsychotics; in patients with a history of violence it allows them to reengage safely with society and family after forensic and prison settings [8]. There is strong evidence that patients with schizophrenia on clozapine -despite being classified as treatment-resistant -are significantly more likely to live independently and to be employed when compared to other medications [9]. Finally, in a recent study of 66,681 patients followed over 11-years, patients on clozapine were shown to have the lowest overall mortality and fewest deaths due to ischemic heart disease as compared to the eight most commonly used typical and atypical antipsychotic agents [10].…”

Subtyping Schizophrenia by Treatment Response: Antipsychotic Development and the Central Role of Positive Symptoms

“…34 Similarly, patients meeting criteria for TRS frequently demonstrate a favourable response to clozapine, but this is not necessarily matched by improvements in functional measures. 22,35 Longer-term, follow-up studies have also demonstrated that clinical and functional recovery do not parallel each other across time. 23 More recently, it has been argued that other symptom domains may play a more critical role in functional outcome.…”

Negative symptoms of schizophrenia: A historical, contemporary, and futuristic view

“…[1][2][3] Schizophrenia is a devastating condition for those that are afflicted as well as their families and friends. Further schizophrenia, also exacts a tremendous toll upon society, economically through service utilization, and lost productivity.…”