Add-on filgrastim during clozapine rechallenge unsuccessful in preventing agranulocytosis

Hazewinkel, Andreia W.P.; Bogers, Jan P.A.M.; Giltay, Erik J.

doi:10.1016/j.genhosppsych.2013.01.002

Cited by 16 publications

(10 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…More research is needed both on this subject and on the appropriate time delay to restarting clozapine after an episode of neutropenia or agranulocytosis. Additionally, six cases out of seven cases in our analysis reported use of either lithium or G-CSF to increase the ANC (39, 46, 49, 56, 57, 59), clouding the role of the titration speed. Lithium and G-CSF can have protective role against neutropenia or agranulocytosis, but the evidence supporting this strategy is not incontrovertible, as demonstrated by the one failed case reported here (56) and other reports (32, 34, 36).…”

Section: Discussionmentioning

confidence: 79%

“…In all, these reports represented 146 unique patients, of whom 37 (25%) failed rechallenge, comparable to previous rates (31). Only seven studies, all case reports, unambiguously reported clozapine re-titration dosing schedules during rechallenge (39, 49, 50, 53, 56, 57, 59). Refer to Figure 2 for a comparison of published titration speeds.…”

Section: Discussionmentioning

confidence: 99%

“…Five were cases of rechallenge after neutropenia (ANC <1500 cells/mm 3 ) and two were cases of rechallenge after agranulocytosis (ANC<500 cells/mm 3 ). Only one of the seven cases, an individual who had previously developed agranulocytosis, failed rechallenge (56). Time between prior blood dyscrasia and rechallenge was provided for five cases and ranged from 4 days to 4 years.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Re-titration rates after clozapine-induced neutropenia or agranulocytosis: A case report and literature review

Boazak¹,

Kahn²,

Cox

et al. 2018

Clinical Schizophrenia & Related Psychoses

View full text Add to dashboard Cite

Clozapine-induced neutropenia occurs in 3-5% of individuals treated with clozapine. Current US guidelines require interruption of clozapine when the absolute neutrophil count (ANC) drops below 1000 cells/mm. There is minimal available guidance for what dosing schedule to use when restarting clozapine after an episode of neutropenia. Here, we present a case of a 50-year-old Caucasian female with a history of schizoaffective disorder who was successfully rechallenged on clozapine one month after developing clozapine-induced neutropenia (ANC 600 cells/mm). To understand published re-titration rates of clozapine after neutropenia, we conducted a literature review using a using the PubMed database and found only seven case reports that unambiguously reported a clozapine dosing schedule during re-challenge. All were successful except one, a case of clozapine rechallenge after agranulocytosis. Including this case presentation, six out of eight cases restarted clozapine more cautiously than recommended by the US guidelines for a new clozapine initiation. We cannot comment what role a slower or more rapid titration plays in a successful rechallenge after neutropenia with the available evidence. We encourage researchers to publish their dosing schedule in detail after an episode of neutropenia or agranulocytosis.

show abstract

Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Re-titration rates after clozapine-induced neutropenia or agranulocytosis: A case report and literature review

Boazak¹,

Kahn²,

Cox

et al. 2018

Clinical Schizophrenia & Related Psychoses

View full text Add to dashboard Cite

show abstract

“…Most importantly, there is a lack of conclusive evidence regarding the use of CSFs for this indication. As demonstrated in several case reports, if a patient encounters agranulocytosis whereby antibody crosslinking and hapten-carriers target neutrophils for cell-mediated or apoptotic death, CSFs will likely be unsuccessful 28,29…”

Section: Discussion: Responding To Clozapine-induced Neutropenia and mentioning

confidence: 99%

Utilization of G-CSF and GM-CSF as an alternative to discontinuation in clozapine-induced neutropenia or leukopenia: A case report and discussion

Karst

Lister

2018

Mental Health Clinician

View full text Add to dashboard Cite

Clozapine remains the definitive gold standard for treatment-resistant schizophrenia despite limitations in use because of hematological abnormalities. Neutropenia or leukopenia are often treated with interruption of clozapine treatment, frequently resulting in clinical decompensation, hospitalization, increased burden to patient care, and increased risk of suicide. Colony-stimulating factors, including granulocyte colony-stimulating factors and granulocyte-macrophage colony-stimulating factors, are cytokines that stimulate proliferation and differentiation of myeloid precursor cells. Their use in the prevention and treatment of clozapine-associated neutropenia presents an alternative to clozapine discontinuation in certain cases. We present a case report of successful periodic granulocyte-macrophage colony-stimulating factor use with clozapine in a patient with treatment-resistant schizophrenia, as well as discussion of a practical approach to patients with possible clozapine-induced neutropenia or leukopenia.

show abstract

“…Treatment of clozapine‐induced agranulocytosis consists of immediate clozapine cessation, and consideration of initiation of prophylactic broad‐spectrum antibiotics and granulocyte colony‐stimulating factor (such as filgrastim) until the granulocyte count normalizes . Although few case reports describe successful clozapine rechallenge in patients with a history of agranulocytosis, the data are sparse, and current practice is to permanently discontinue clozapine if ANC falls below 1000/mm 3 …”

Section: Hematologicmentioning

confidence: 99%

Medical management of patients on clozapine: A guide for internists

Lundblad

Azzam

Gopalan

et al. 2015

Journal of Hospital Medicine

View full text Add to dashboard Cite

Clozapine was approved by the US Food and Drug Administration in 1989 for the management of treatment‐resistant schizophrenia, and has since proven to reduce symptom burden and suicide risk, increase quality of life, and reduce substance use in individuals with psychotic disorders. Nevertheless, clozapine's psychiatric benefits have been matched by its adverse effect profile. Because they are likely to encounter medical complications of clozapine during admissions or consultations for other services, hospitalists are compelled to maintain an appreciation for these iatrogenic conditions. The authors outline common (eg, constipation, sialorrhea, weight gain) and serious (eg, agranulocytosis, seizures, myocarditis) medical complications of clozapine treatment, with internist‐targeted recommendations for management, including indications for clozapine discontinuation. Journal of Hospital Medicine 2015;10:537–543. © 2015 Society of Hospital Medicine

show abstract

Add-on filgrastim during clozapine rechallenge unsuccessful in preventing agranulocytosis

Cited by 16 publications

References 12 publications

Re-titration rates after clozapine-induced neutropenia or agranulocytosis: A case report and literature review

Re-titration rates after clozapine-induced neutropenia or agranulocytosis: A case report and literature review

Utilization of G-CSF and GM-CSF as an alternative to discontinuation in clozapine-induced neutropenia or leukopenia: A case report and discussion

Medical management of patients on clozapine: A guide for internists

Contact Info

Product

Resources

About