Clozapine-induced leukopenia: arguments for rechallenge

Bogers, Jan P.A.M.; Cohen, Daniel; Schulte, Peter F.J.; Dijk, D. van; Bakker, Bert

doi:10.1007/s11845-011-0782-5

Cited by 5 publications

(2 citation statements)

References 7 publications

(8 reference statements)

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“…14 If at any time during treatment the white blood cell count falls below 3000 cells mm −3 or the ANC below 1500 cells mm −3 , clozapine should be discontinued immediately and these patients should not be treated with clozapine again except in a controlled setting. 15 , 16 , 17 Although the obligatory monitoring has the benefit of regular contact with a health-care professional, it is an invasive procedure and can be a burden for the patient. Moreover, some patients decline to take clozapine because of the monitoring requirement.…”

Section: Introductionmentioning

confidence: 99%

Establishing the characteristics of an effective pharmacogenetic test for clozapine-induced agranulocytosis

et al. 2015

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Clozapine is the only evidence-based therapy for treatment-resistant schizophrenia, but it induces agranulocytosis, a rare but potentially fatal haematological adverse reaction, in less than 1% of users. To improve safety, the drug is subject to mandatory haematological monitoring throughout the course of treatment, which is burdensome for the patient and one of the main reasons clozapine is underused. Therefore, a pharmacogenetic test is clinically useful if it identifies a group of patients for whom the agranulocytosis risk is low enough to alleviate monitoring requirements. Assuming a genotypic marker stratifies patients into a high-risk and a low-risk group, we explore the relationship between test sensitivity, group size and agranulocytosis risk. High sensitivity minimizes the agranulocytosis risk in the low-risk group and is essential for clinical utility, in particular in combination with a small high-risk group.

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Section: Introductionmentioning

confidence: 99%

Establishing the characteristics of an effective pharmacogenetic test for clozapine-induced agranulocytosis

et al. 2015

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“…If at any time during treatment the white blood cell count falls below 3000cells/mm³ or the ANC below 1500 cells/mm³, clozapine should be discontinued immediately and these patients should not be treated with clozapine again except in a controlled setting. 15-17 Although the obligatory monitoring has the benefit of regular contact with a health care professional, it is an invasive procedure and can be a burden for the patient. Moreover, some patients decline to take clozapine because of the monitoring requirement 18…”

Section: Introductionmentioning

confidence: 99%

Establishing the characteristics of an effective pharmacogenetic test for clozapine induced agranulocytosis

Verbelen

Collier

Cohen³

et al. 2014

Preprint

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Clozapine Rechallenge After Neutropenia or Leucopenia

Prokopez¹,

Armesto

Aguer

et al. 2016

J Clin Psychopharmacol

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To rechallenge with clozapine for a patient who previously has experienced neutropenia or leucopenia or during clozapine treatment is a difficult clinical decision. Herein, we analyzed the results of such a rechallenge in 19 patients. We analyzed all the reports, from the database of the pharmacovigilance department of the Argentine National Administration of Drugs, Foods, and Medical Devices, of patients who were rechallenged with clozapine after a leucopenia or a neutropenia. Nineteen cases of rechallenge after leucopenia or neutropenia were reported between 1996 and 2014. One third of the patients re-exposed to clozapine developed a new hematologic adverse reaction. The second blood dyscrasia was less severe in 83% of the cases and had a shorter median latency as compared with the first (8 weeks vs 182 weeks, P = 0.0045). There were no significant differences for demographic and clinical characteristics of patients who developed a second dyscrasia as compared with those who did not. The present study shows that almost 70% of the patients rechallenged with clozapine after a leucopenia or a neutropenia did not develop a new hematological adverse effect, whereas the remaining 30% had a faster but less serious neutropenia.

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Clozapine-induced leukopenia: arguments for rechallenge

Cited by 5 publications

References 7 publications

Establishing the characteristics of an effective pharmacogenetic test for clozapine-induced agranulocytosis

Establishing the characteristics of an effective pharmacogenetic test for clozapine-induced agranulocytosis

Establishing the characteristics of an effective pharmacogenetic test for clozapine induced agranulocytosis

Clozapine Rechallenge After Neutropenia or Leucopenia

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