Clozapine, neutropenia and Covid-19: should clinicians be concerned? 3 months report

Bonaccorso, Stefania; Ricciardi, Angelo; Ouabbou, Sophie; Theleritis, Christos; Ross-Michaelides, Arabella; Metastasio, Antonio; Stewart, Neil; Mohammed, M.; Schifano, Fabrizio

doi:10.1016/j.bbih.2021.100212

Cited by 18 publications

(26 citation statements)

References 29 publications

(27 reference statements)

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“…Interestingly, the clozapine effect is only restricted to neutrophils but not lymphocytes [ 21 , 22 ]. These findings were further supported by clinical findings that showed a transient elevation of neutrophil levels in a cohort of 100 patients in the first few weeks of clozapine treatment [ 17 ]. This transient elevation in the neutrophil count subsequently normalizes, however in a smaller cohort of patients, clozapine eventually induced neutropenia or agranulocytosis.…”

Section: The Mechanisms Of Clozapine-induced Neutropeniasupporting

confidence: 58%

“…On the other hand, Bonaccorso, et al [ 17 ] found a significant reduction and improvement during and post-COVID-19 infection, respectively, among ten patients infected with COVID-19. In this cohort, no mortality was reported, and only one patient was admitted to the intensive care unit due to complications.…”

Section: Covid-19 Infection and Neutrophil Count In Patients On Clozapine Treatmentmentioning

confidence: 99%

“…Gee and Taylor [ 18 ] defined 14 days before the positive swab test, 0–7 days, and 8–14 days as the pre-, during, and post-COVID-19 infection period, respectively. On the contrary, Bonaccorso, et al [ 17 ] defined the period based on the average ANC in the previous three years, around three days (±2.83 days) after the onset of the symptoms, and approximately one month after the COVID-19 infection, as pre-, during, and post-COVID-19, respectively. Another reason is probably the difference in the statistical analysis used between studies, with one study utilized a paired t -test [ 18 ], while another used the linear regression method [ 17 ].…”

Section: Covid-19 Infection and Neutrophil Count In Patients On Clozapine Treatmentmentioning

confidence: 99%

“…The infiltration of inflammatory cells in the lung causes massive injury that might attribute to acute respiratory distress syndrome [ 15 ]. On the contrary, growing evidence has reported a reduction in ANC in COVID-19 patients receiving clozapine [ 17 , 18 , 19 ]. The magnitude of ANC reduction is unclear during COVID-19 in patients receiving clozapine.…”

Section: Introductionmentioning

confidence: 99%

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Reduction in Absolute Neutrophil Counts in Patient on Clozapine Infected with COVID-19

Ramli

Ali

Hashim

et al. 2021

IJERPH

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Despite its severe adverse effects, such as agranulocytosis, clozapine is the primary treatment for treatment-resistant schizophrenia. The established clozapine monitoring system has contributed to reducing agranulocytosis incidence and mortality rates. However, the pandemic coronavirus disease 2019 (COVID-19) has caused changes in the monitoring system. This review aimed to assess the current evidence on the neutrophil changes in the patient on clozapine treatment and infected with COVID-19. Individual cases reported various absolute neutrophil count (ANC) levels, normal, reduced, or elevated. No agranulocytosis case was reported. One case had a borderline moderate-severe ANC level, but the patient was in the 18-week period of clozapine treatment. A cumulative analysis of case the series initially reported inconclusive results. However, a more recent study with a larger sample size reported a significant reduction in the ANC during COVID-19 infection. Nevertheless, this effect is transient as no significant difference was found between the baseline and the post-infection period in ANC levels. In conclusion, COVID-19 is associated with a temporary reduction in ANC levels. The results supported the recommendation to reduce the frequency of clozapine monitoring in the eligible candidates. However, more data are required to confirm the current findings given the limitations, including study design, sample size, and statistical analysis.

show abstract

Section: The Mechanisms Of Clozapine-induced Neutropeniasupporting

confidence: 58%

Section: Covid-19 Infection and Neutrophil Count In Patients On Clozapine Treatmentmentioning

confidence: 99%

Section: Covid-19 Infection and Neutrophil Count In Patients On Clozapine Treatmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Reduction in Absolute Neutrophil Counts in Patient on Clozapine Infected with COVID-19

Ramli

Ali

Hashim

et al. 2021

IJERPH

View full text Add to dashboard Cite

show abstract

“…Another suggestion which has been made includes use of vitamin-D in all patients on clozapine to protect them against the likelihood and severity of COVID-19 infection ( Gee et al, 2020 ). Some of the studies have also shown safety of the extended haematological monitoring ( Hata et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%