The impact of clozapine on hospital use: a systematic review and meta‐analysis

Abstract

The impact of clozapine on hospital use: a systematic review and metaanalysis.Objective: The objective of this study was to perform a systematic review and meta-analysis of studies reporting the impact of clozapine on hospital use in people with a psychotic illness. Method: PubMed, EMBASE, PsycINFO and the Cochrane Schizophrenia Group Trials Register were systematically searched from inception to 12 October 2016. We included all trials and observational studies, except case reports. Results: Thirty-seven studies were included. Clozapine significantly reduced the proportion of people hospitalised compared to control medicines (RR = 0.74; 95% CI: 0.69-0.80, P < 0.001, 22 studies, n = 44 718). There were significantly fewer bed days after clozapine treatment compared to before clozapine treatment in both controlled (MD = À34.41 days; 95% CI: À68.22 to À0.60 days, P = 0.046, n = 162) and uncontrolled studies (MD = À52.86 days; 95% CI: À79.86 days to À25.86 days, P < 0.001, n = 2917). Clozapine and control medicines had a similar time to rehospitalisation (À19.90 days; 95% CI: À62.42 to 22.63 days, P = 0.36). Conclusion: Clozapine treatment reduced the number of people hospitalised and the number of bed days after treatment compared with before treatment. Clozapine has the potential to reduce acute hospital use among people with treatment refractory schizophrenia.

Glucagon‐like peptide‐1 receptor agonists for antipsychotic‐associated cardio‐metabolic risk factors: A systematic review and individual participant data meta‐analysis

“…Differences in endpoint body weight between GLP‐1RA treatment and control interventions were greater for patients on clozapine and/or olanzapine, which is consistent with preclinical findings on olanzapine's and clozapine's disruption of the GLP‐1RA pathway . This result is important, as clozapine remains the only antipsychotic indicated for patients with treatment‐resistant schizophrenia, and has the best evidence for managing positive symptoms and reducing hospitalizations in this population. Body weight gain can be both a barrier to commencement of clozapine and a reason for its discontinuation.…”

Consensus statement on the use of clozapine during the COVID-19 pandemic

“…Clozapine is the most effective antipsychotic for reducing positive symptoms, hospital admissions and all-cause mortality in patients with treatmentrefractory schizophrenia. [1][2][3] Owing to the risk of clozapine-associated severe neutropenia, absolute neutrophil count (ANC) monitoring programs are a prerequisite for clozapine dispensation in most jurisdictions globally. 4,5 Regionspecific limits on outings and clinical resource constraints during the COVID-19 pandemic may create challenges for patients to access routine clozapine-associated care, including ANC testing required for dispensing.…”

A Rational Use of Clozapine Based on Adverse Drug Reactions, Pharmacokinetics, and Clinical Pharmacopsychology

“…If one takes a more comprehensive view of what is important in clinical practice [126], and considers effectiveness based on two systematic reviews of naturalistic cohort studies [127,128], clozapine was superior to other antipsychotics in decreasing discontinuation and decreasing hospitalization.…”

“…The importance of well-being during pharmacotherapy is receiving more and more attention [129] and is particularly relevant in explaining the high adherence of some patients to clozapine, demonstrated by the lower discontinuation rates in cohort studies [127,128]. Clozapine positive effects on well-being in some patients may be influenced by clozapine effects on extrapyramidal symptoms [130][131][132][133][134][135][136][137][138][139][140][141][142], hostility [143,144] and the "awakening" phenomenon [145][146][147] (online suppl.…”