Long-term outcomes of delayed clozapine initiation in treatment-resistant schizophrenia: a multicenter retrospective cohort study

BMC Psychiatry

Research

Kiyotaka Tsubouchi¹  Shogo Hotta²  Shigeki Yamada³  Masakazu Hatano⁴  Yoshihito Shimizu⁵  Satoru Esumi⁶  Hiroyuki Kamei⁷  Takashi Sakakibara⁸  Ippei Takeuchi⁹  Kazuhiko Gomi^1,10 

[1] Department of Hospital Pharmacy, Kanazawa University, Kanazawa, Japan;Department of Hospital Pharmacy, Nagoya University School of Medicine, Nagoya, Japan;Division of Clinical Sciences and Neuropsychopharmacology, Graduate School of Pharmacy, Meijo University, Nagoya, Japan;Department of Pharmacotherapeutics and Informatics, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, Japan;Department of Pharmacotherapeutics and Informatics, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, Japan;Office of Clinical Pharmacy Practice and Health Care Management, Faculty of Pharmacy, Meijo University, Nagoya, Japan;Department of Pharmacy, Kanazawa Medical University Hospital, Kahoku, Japan;Department of Pharmacy, Okayama University Hospital, Okayama, Japan;The Faculty of Pharmaceutical Sciences, Kobe Gakuin University, Kobe, Japan;Office of Clinical Pharmacy Practice and Health Care Management, Faculty of Pharmacy, Meijo University, Nagoya, Japan;Office of Clinical Pharmacy Practice and Health Care Management, Faculty of Pharmacy, Meijo University, Nagoya, Japan;Department of Psychiatry, Holy Cross Hospital, Toki, Japan;Office of Clinical Pharmacy Practice and Health Care Management, Faculty of Pharmacy, Meijo University, Nagoya, Japan;Department of Psychiatry, Okehazama Hospital, Toyoake, Japan;Office of Clinical Pharmacy Practice and Health Care Management, Faculty of Pharmacy, Meijo University, Nagoya, Japan;Nagano Prefectural Mental Wellness Center Komagane, Komagane, Japan;

关键词: Antipsychotic agents;    Time-to-treatment;    Hospitalization;    Early medical intervention;    Secondary prevention;   

DOI  :  10.1186/s12888-023-05176-y

 received in 2023-05-23, accepted in 2023-09-09,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundClozapine is the only antipsychotic medication with proven efficacy against treatment-resistant schizophrenia. This multicenter retrospective cohort study aimed to evaluate the impact of a delay in clozapine initiation on long-term outcomes.MethodsPatients who initiated clozapine treatment between July 2009 and December 2018 were included in this study. According to the length of time from the diagnosis of schizophrenia to clozapine initiation, the patients were categorized into one of three groups: early (≤ 9 years), intermediate (10–19 years), and late (≥ 20 years) initiation. The endpoints were psychiatric rehospitalization and all-cause clozapine discontinuation within 3 years. Hazard ratios (HR) and 95% confidence interval (CI) were estimated using the Fine and Gray method or the Cox proportional hazards model.ResultsThe incidence rates of rehospitalization within three years, according to the cumulative incidence function, were 32.3% for early, 29.7% for intermediate, and 62.2% for late initiation, respectively. Late initiation had a significantly higher risk of psychiatric rehospitalization than early initiation (HR, 2.94; 95% CI, 1.01– 8.55; P = 0.016 by the Gray's test). The risk of psychiatric rehospitalization was not significantly different between the early and intermediate initiation groups. The incidence rate of all-cause clozapine discontinuation within three years using the Kaplan–Meier method was 13.0% for early, 10.6% for intermediate, and 20.1% for late initiation. The risk of all-cause clozapine discontinuation was not significantly among the groups. The late initiation group had more patients discontinuing because of death due to physical diseases than the other groups.ConclusionsThe study suggests that clozapine should be initiated promptly in patients with treatment-resistant schizophrenia to prevent psychiatric rehospitalization during long-term treatment. Further prospective studies with appropriate consideration of confounding factors and large sample sizes are needed to strengthen the evidence.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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