Real‐world effectiveness of clozapine in patients with bipolar disorder: results from a 2‐year mirror‐image study

Abstract

Clozapine use for BD was associated with a significant and clinically relevant reduction in the number of bed-days, psychiatric admissions, psychotropic co-medications, and hospital contact for self-harm/overdose, without increased medical treatments. Clozapine seems to be an appropriate choice for treatment-resistant BD and should be investigated in randomized controlled trials.

Clozapine for treatment-resistant bipolar disorder: a systematic review

“…However, we have included them in Table 4 and provided a brief statement on them for the sake of entirety. The retrospective open study by Nielsen et al (51) was included in this review (Table 2), although the sample also included patients with non-TRBD; it was not possible to exclude them. All tables provided details of the contamination of the studies by other diagnoses when it was not possible to separate the patients.…”

Switching Bipolar Disorder Patients Treated with Clozapine to Another Antipsychotic Medication: A Mirror Image Study

“…16,[24][25][26][27][28][29][30][31] Furthermore, clozapine use reduced psychiatric hospitalization and emergency room visits, numbers and length of psychiatric admissions, and psychotropic comedications, in patients with BD. 15,32 …”

“…[7][8][9][10][11] Although clozapine has never been approved for the treatment of bipolar disorder, it has showed efficacy in acute mania with psychosis and for the treatment of refractory symptoms associated with BD. [12][13][14][15][16] The efficacy of clozapine in severe manic patients was reported both as monotherapy and as an add-on strategy. 17 Despite this evidence, clozapine remains underutilized in general 18 and in BD in particular, mostly due to tolerability and safety concerns.…”

Factors Associated with Costs of Hospitalization of Severely Mentally Ill Patients

“…It is notable, for example, that use of clozapine has been associated with savings in treatment costs in other circumstances notably, in comparisons of similarly severely ill subjects treated with this unusually effective drug versus others [56,57]. Here, however, use of clozapine evidently signals unusually severe and otherwise inadequately treatment-responsive illness.…”