Utility and Barriers to Clozapine Use

Zheng, Shushan; Lee, Jimmy

doi:10.4088/jcp.21m14231

Cited by 7 publications

(7 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Consistent evidence has demonstrated widespread underuse and variation of clozapine prescribing and this is seemingly more prevalent in EIP services 3 . Barriers to improved clozapine treatment have been previously studied and can be broadly divided into patient, clinician and administrative 10 , 11 , 26 , 27 , which our survey also identified. A previous review on the barriers to the use of clozapine highlighted insufficient prescriber training; concern over rare, but serious side effects (including agranulocytosis and myocarditis); frequent blood tests; relatively high administrative burden; and side effects (including weight gain, sedation, and hypersalivation) as prominent barriers 10 .…”

Section: Discussionmentioning

confidence: 99%

What are the barriers and facilitators of clozapine use in early psychosis? A survey of UK early intervention clinicians

Oloyede¹,

Blackman²,

Mantell³

et al. 2023

Schizophr

View full text Add to dashboard Cite

Clozapine is the most effective medication for treatment-resistant psychosis, but evidence points to substantial underuse, especially within early intervention psychosis (EIP) services. We explored clinicians’ views on perceived barriers and facilitators to offering patients clozapine within EIP services. A cross-sectional survey was distributed electronically to clinicians practising in EIP services across England. A mixed methods approach was used to assess barriers to clozapine, and attitudes and opinions concerning clozapine underutilisation. Based on the barriers identified in the literature, clinicians were asked to rate each one (scale:1-7) based on importance, with a higher score indicating higher importance. Clinicians were also asked open-ended questions on barriers to clozapine and how access can be improved in EIP services. Quantitative data were analysed using descriptive and inferential statistics, and qualitative responses were analysed thematically. One hundred and nineteen EIP clinicians from 35 services in England completed the survey. In total, 37% (n = 45) of clinicians perceived that clozapine was under-prescribed in their EIP service. The most important barrier to utilising clozapine were patient concerns with side effects, followed by monitoring requirements and clinician concerns with side effects. Thematic analysis identified 17 perceived barriers, which were grouped into three major themes: administrative (5 subthemes), clinician-related (6 subthemes), and patient-related (6 subthemes). Perceived facilitators to improving clozapine use were greater training, improved resources, and optimised monitoring. The main barriers to clozapine in EIP services, as identified by clinicians, are patient concerns regarding side effects and monitoring requirements. Identified facilitators for improved clozapine use include clinician training, improved resources, guidelines, and point-of-care testing.

show abstract

Section: Discussionmentioning

confidence: 99%

What are the barriers and facilitators of clozapine use in early psychosis? A survey of UK early intervention clinicians

Oloyede¹,

Blackman²,

Mantell³

et al. 2023

Schizophr

View full text Add to dashboard Cite

show abstract

“…No other published studies within the identified underprioritized areas were found. Instead, eight additional studies on general clinician perspectives on clozapine treatment [203][204][205][206][207][208][209][210] , three additional studies on clozapinepatients' (and their clinicians') attitudes towards their ongoing treatment 40 211 212 , and three additional studies on case-note derived reasons for clozapine cessation or withholding [213][214][215] appeared, ratifying the repetitive behavior of current research and the importance of disseminating these results in order to direct future research towards more meaningful and less well-described areas.…”

Section: Summary Of Evidencementioning

confidence: 99%

What is the extent of research assessing patients’ and clinicians’ perspectives on clozapine treatment? – a comprehensive scoping review

Jakobsen,

Schaug,

Storebø

et al. 2024

Preprint

View full text Add to dashboard Cite

BackgroundThe atypical antipsychotic clozapine is the gold standard for treating treatment-resistant schizophrenia; however, it is continuously underutilized in most parts of the world.A few systematic reviews addressing barriers to clozapine prescribing have previously been conducted, primarily focusing on clinical staff’s attitudes and perceived barriers to prescribing. However, a preliminary literature search revealed that additional literature on the subject does exist, including literature on patient perspectives, without having been included in any of the former reviews.It is therefore difficult to conclude if the former synthesizes of the literature are representative of current evidence, and if the topic has been adequately investigated to inform clinical practice. A scoping review is warranted to map and synthesize a broader scope of primary studies on patients’ and/or clinicians’ perspectives on clozapine treatment to identify any gaps for future research.MethodsThe electronic databases Cochrane Library, CINAHL, Web of Science, Psychinfo, MEDLINE, and EMBASE were searched, supplied with searches of Google Scholar, The Networked Digital Library of Theses and Dissertations (NDLTD), and OpenGrey. Citation tracking of selected studies was furthermore undertaken. Two researchers independently screened and extracted the data.RegistrationPROSPERO does not offer registration of scoping reviews; however, the protocol was prospectively registered with the Open Science Framework and subsequently published as an article.ResultsOne hundred and forty-six studies were included. Most studies reported upon patients’ or clinicians’ perspectives on active clozapine treatment or on clinicians’ general perspectives on barriers to clozapine initiation. Three apparent gaps in research were identified: 1) clozapine eligible, yet clozapine-naïve, outpatients’ attitudes towards clozapine commencement, 2) assessments of clinicians’ reasons for clozapine withholding and perceived facilitators of clozapine treatment in specific patient-cases, and 3) direct assessments of both patient and clinician perspectives on clozapine discontinuation, continuation and re-challenge in specific patient-cases.ConclusionsResearch regarding perspectives on clozapine treatment tends to repeat itself. Future studies addressing the identified gaps in evidence are warranted and could provide the insights needed to optimize clozapine utilization.Strengths and limitations of this study:The prospective registration and publication of the review protocol has ensured transparency of the review process.The search strategy has ensured a comprehensive search of the literature and multiple booster searches on Google Scholar have ensured a continued update on the scope of literature, the most recent one in January 2024.The original literature search was conducted in June 2021.The search was restricted to publications in the English language, which may have precluded the identification of some relevant insights and studies.

show abstract

“…Despite the overwhelmingly favorable evidence, which is reflected in unanimous guideline recommendations [49 ▪▪ ], clozapine remains severely underused across industrialized countries [5,50 ▪ ,51 ▪ ] with underutilization apparently most pronounced in female TRS patients [52 ▪ ]. There are notable differences between and within countries, which might offer important clues for the underlying causes.…”

Section: Clozapine Underutilizationmentioning

confidence: 99%

“…Clozapine underutilization appears to be attributable particularly to clinician's concerns regarding potential side effects, especially an overestimation of the risks associated with blood dyscrasia [50 ▪ ,53,55,56] and a lack of resources for blood sampling and other monitoring procedures [53]. Clinician's apprehension appears to be further amplified by limited knowledge regarding treatment algorithms and side effect management [53,55,57,58].…”

Section: Attitude Of Psychiatrists Towards Clozapinementioning

confidence: 99%

The ever-growing case for clozapine in the treatment of schizophrenia: an obligation for psychiatrists and psychiatry

Bittner

Reif

Qubad

2023

Current Opinion in Psychiatry

View full text Add to dashboard Cite

Purpose of reviewClozapine remains the gold standard for treatment-resistant schizophrenia (TRS). Although the evidence base for its wide-ranging, unique efficacy continues to expand, clozapine remains alarmingly underutilized in industrialized countries. Analyzing the causes and consequences of this problem is crucial for substantially improving the quality of care for TRS patients.Recent findingsClozapine is the most effective antipsychotic for reducing all-cause mortality in TRS. In most cases, treatment resistance emerges during the first psychotic episode. Delaying clozapine treatment has a negative impact on long-term outcome. Patients’ experience with clozapine treatment is largely positive despite a comparatively high rate of side effects. Patients prefer clozapine, while psychiatrists regard it as a burden due to concerns regarding safety and side effect management. Shared decision-making (SDM), which increases the likelihood of a clozapine recommendation, is not routinely used, possibly due to stigmatization of TRS patients.SummaryThe mortality-reducing effects of clozapine alone warrant its regular use. Therefore, psychiatrists must not exclude patients from the decision regarding a clozapine trial by not even offering it. Rather, they have a clear obligation to align their actions more closely with the existing evidence and patients’ needs and to facilitate the timely initiation of clozapine.

show abstract

Utility and Barriers to Clozapine Use

Cited by 7 publications

References 0 publications

What are the barriers and facilitators of clozapine use in early psychosis? A survey of UK early intervention clinicians

What are the barriers and facilitators of clozapine use in early psychosis? A survey of UK early intervention clinicians

What is the extent of research assessing patients’ and clinicians’ perspectives on clozapine treatment? – a comprehensive scoping review

The ever-growing case for clozapine in the treatment of schizophrenia: an obligation for psychiatrists and psychiatry

Contact Info

Product

Resources

About