Clozapine Eligibility Among State Hospital Patients

Abstract

Connecticut State Hospital's entire resident population (n = 1,300) was screened on an arbitrary target day to determine eligibility for clozapine. Sixty percent of 803 patients with schizophrenia or schizoaffective disorder diagnoses met Food and Drug Administration (FDA)- approved criteria for clozapine use as judged by review of past medication trial records and by the responsible physicians. Eighty-eight percent of these patients were medically cleared, and of those cleared, 63 percent agreed to clozapine treatment. Of the patients who began a clozapine trial, 76 percent were still taking the drug 12 months later. Preliminary findings from a randomized trial of clozapine versus usual care (n = 227) indicate that discharge rates associated with clozapine and usual care do not differ. Once discharged, however, patients assigned to clozapine are less likely to be readmitted. Hence, clozapine may be more cost-effective than usual care. However, before savings can be realized, State governments will have to make up-front investments of approximately $140 million simply to give patients hospitalized on a single day a year's access to clozapine.

Clozapine but not Haloperidol Re-establishes Normal Task-Activated rCBF Patterns in Schizophrenia within the Anterior Cingulate Cortex

“…Subsequent studies have confirmed these results (Rosenheck et al, 1997;Buchanan et al, 1998;Pickar et al, 1992;Breier et al, 1994;Essock et al, 1996;Conley et al, 1999). The advantage of clozapine over a firstgeneration antipsychotic medication was also found in partially responsive, community-based, schizophrenic patients (Kane et al, 2001;Buchanan et al, 1998;Breier et al, 1994).…”

Diretrizes da Federação Mundial das Sociedades de Psiquiatria Biológica para o tratamento biológico da esquizofrenia. Parte 2: tratamento de longo prazo

“…Não ficou claro se as vantagens das medicações psicóticas atípicas na prevenção da recaída eram decorrentes de sua melhor eficácia, sua melhor tolerabilidade ou à melhor aderência ao tratamento. Para os dados reunidos de estudos individuais, apenas a risperidona (Csernansky et al, 2002;Marder et al, 2003) e a olanzapina , mas não a clozapina (Essock et al, 1996a(Essock et al, e 1996bRosenheck et al, 1999aRosenheck et al, , 1999bRosenheck et al, e 2000Tamminga et al, 1994) ou a amisulprida (Speller et al, 1997), mostraram ser significativamente superiores aos APGs (Leucht et al, 2003b). Embora o índice de recaída não fosse significativamente menor, o tratamento com a clozapina se mostrou associado à permanência mais longa na comunidade (Leucht et al, 2003b) e a menores taxas de readmissão hospitalar (Essock et al, 1996a(Essock et al, e 1996b.…”

“…A clozapina revelou superioridade na melhora dos sintomas positivos durante ECR de longo prazo (mais de 6 meses), em que foi comparada ao haloperidol (Kane et al, 2001), efeito que seria confirmado futuramente em estudos abertos (Essock et al, 1996a(Essock et al, e 1996bRosenheck et al, 1999aRosenheck et al, e 1999b. A clozapina demonstrou habilidade para melhorar significativamente os sintomas negativos quando comparada aos APGs num estudo aberto com duração de 1 ano (Meltzer et al, 1989).…”

Time to clozapine response in a standardized trial

“…A bout one-third of all people with schizophrenia are substantially resistant to drug treatment; this has been a consistent finding over time (1,2). Because of this resistance, there was much enthusiasm after the clinical introduction of clozapine.…”