Patterns of clozapine and other antipsychotics prescriptions in patients with treatment-resistant schizophrenia in community mental health centers in São Paulo, Brazil

Abstract

Background: Despite of its global underuse, clozapine is still the golden standard antipsychotic for patients with treatment-resistant schizophrenia (TRS). Objective: To evaluate the patterns of clozapine and other antipsychotic drugs prescription in TRS in community mental health centers in São Paulo, Brazil. Methods: A multiple-choice questionnaire was applied to fifteen psychiatrists at five centers inquiring about patients' clinical condition, adherence to oral treatment and current antipsychotic treatment. History of previous and current antipsychotic treatment was collected through medical chart review. Results: Out of 442 schizophrenia patients, 103 (23.3%) fulfilled the criteria for TRS. Fifty-eight patients (56.3%) were receiving polypharmacy; 30 (29.1%) were on atypical antipsychotic monotherapy, 14 (13.6%) were on typical antipsychotic monotherapy, 25 (24.3%) were taking depot antipsychotic medication and only 22 (21.4%) were receiving clozapine. Discussion: As well as in other parts of the world, many TRS patients (78.6%) receive other drugs instead of clozapine in São Paulo, the best evidence-based medication for patients with TRS. The government should make every effort to provide medical training and the equipment and logistic support to adequately serve those who could benefit from clozapine treatment at the community health centers.

Haematologic malignancies associated with clozapine v. all other antipsychotic agents: a pharmacovigilance study in VigiBase®

“…While men and women have a similar prevalence of schizophrenia (Li, Ma, Wang, Yang, & Wang, 2016), there are important gender differences in clozapine prescription. Indeed, it has been reported in several studies that, similarly to our data, males represented between 63.1% and 78.6% of the patients treated with clozapine (de Silveira et al, 2015; Taylor, 2004). Thus, we propose that sex is not a risk factor for clozapine-induced haematological disorders.…”

Prevalence and predictors of treatment-resistant schizophrenia in a tertiary hospital in Northeast Brazil

“…12,16,28 Despite these benefits, many obstacles for clozapine prescription remain, and a study in Brazil has described difficult access, poor adhesion to blood count routine, fear of side effects and little knowledge about the medication on the part of clinicians as the main reasons for low clozapine use. 29 Even when clozapine is prescribed, there tends to be a delay in its initiation, leading to more severe symptoms, lower clozapine response and more electroconvulsive therapy indication. 30,31 In the present study, just a small percentage of the patients with TRS did not use clozapine, because of intolerable side effects or no adhesion to routine blood tests.…”

Attitudes to antipsychotics: a multi-site survey of Canadian psychiatry residents

“…Although some have criticized the methodology and generalizability of these two major studies (Lewis and Lieberman, 2008), CATIE and CUtLASS are still the two largest non-commercial clinical trials comparing FGAs and SGAs directly for the treatment of schizophrenia. However, despite the research evidence from these two studies, current international psychiatric practices are dominated by the use of SGAs (Bret et al, 2009;Koranek et al, 2012;Park et al, 2014), while the use of FGAs, LAIs and clozapine appears to be less popular (Bret et al, 2009;Koranek et al, 2012;Park et al, 2014;Dibben et al, 2016;Silveira et al, 2015).…”