Clozapine Prescribing in a Canadian Outpatient Population

Alessi‐Severini, Silvia; Dorze, Josee-Anne Le; Nguyen, David; Honcharik, Patricia L.; Eleff, Michael

doi:10.1371/journal.pone.0083539

Cited by 30 publications

(32 citation statements)

References 12 publications

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“…The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study showed that antipsychotic combination was more prescribed to patients with high levels of symptoms, but in the end, it did not differ in terms of improving efficacy measures compared to antipsychotic monotherapy 21 . Howes et al 22 and AlessiSeverini et al 23 carried out studies at Mental Health Centers in England and Canada, respectively, and found out that polypharmacy and three or more tries of antipsychotic treatment was a common feature before the initiation of clozapine. Regarding the patients with TRS, some meta-analyses support combining another antipsychotic with clozapine in patients who do not respond fully to this medication 16,24,25 but the evidence of efficacy of these augmentation strategies is also scarce 24 .…”

Section: Discussionmentioning

confidence: 99%

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

Silveira¹,

Rocha²,

Àttux³

et al. 2015

Arch. Clin. Psychiatry (São Paulo)

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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.

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Section: Discussionmentioning

confidence: 99%

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

Silveira¹,

Rocha²,

Àttux³

et al. 2015

Arch. Clin. Psychiatry (São Paulo)

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“…In a recent review which investigated international trend for clozapine use in 17 countries, it was concluded that while clozapine use has increased in most studied countries over recent years, clozapine is still underused in many countries and clozapine utilization patterns differed significantly between these countries [26]. For example, a recent Canadian study, based on physician drug recommendation from 2005 to 2009, showed a 48% increase in clozapine recommendations over a 5- year period [27]; however, a more recent study reported that 68% of outpatients had tried three or more antipsychotics before switching to clozapine [28]. Data from 60% of the mental health trusts in England showed that only 30% of those eligible were actually receiving clozapine [29].…”

Section: Discussionmentioning

confidence: 99%

Prescribing trends in treatment-resistant schizophrenia

Görmez

Kurtulmuş

Can

2017

Psychiatry and Clinical Psychopharmacology

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Objectives: Schizophrenia is a common mental health condition associated with significant morbidity and excess early mortality. Treatment-resistant schizophrenia (TRS) occurs in about one in three patients diagnosed with schizophrenia. The aim of this study was to identify attitudes of a nationally representative sample of psychiatrists towards pharmacotherapy of patients with TRS, the potential factors related to their choice of various regimens, and to investigate the clinical outcomes of different methods employed. Methods: Psychiatrists were contacted through national e-groups and various psychiatry conventions. They provided information about their professional and demographic characteristics. They were asked to describe clinical and demographic characteristics of an adult patient with TRS under their care for at least 3 months. They reported on the medication change they made and the effect of this intervention on the positive symptoms and functioning of the patient. Results: Among the 207 patients reported on, only 28.7% were on monotherapy for TRS immediately before the change in medication. With the change made in treatment regime, 40.1% were switched to a different antipsychotic agent as monotherapy, 40.6% received combination therapy with two or more antipsychotic agents, 1.4% received high-dose antipsychotics, and 4.8% had augmentation with antidepressants or mood stabilizers. 13.1% psychiatrists employed more than one method. Of the whole sample, 48.3% were put on clozapine either as monotherapy or with other medications. The monotherapy and combination groups were compared in terms of characteristics of patients and prescribers, which revealed no significant difference (p > .05). There was also no difference found on the outcome variables of two groups (p > .05). Conclusions: Although polypharmacy was found to be a common practice, there seemed to be a comparably good ratio of clozapine utilization and of attempts of switching to monotherapy among the prescribers. There were no significant patient-or prescriber-related factors in relation to preference of treatment regimens, which need further investigation on larger samples. ARTICLE HISTORY

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“…During phase 3 of the CATIE study, 51% of patients had previously discontinued medications due to ineffective therapeutic response, but only 11% of patients were offered clozapine during phase 3. Studies of clozapine utilization have shown that adherence to guidelines has been poor through the years with clozapine been consistently underutilized in the US, UK, Canada, New Zealand and Australia [9,[21][22][23][24][25][26][42][43][44][45][46]. In a study of the Veterans Health Administration, only 2% of patients affected by schizophrenia were receiving clozapine [22].…”

Section: Clozapine Prescribing Trendsmentioning

confidence: 99%

“…Recent Canadian statistics, based on physician drug recommendations from 2005 to 2009, show a 48% increase in clozapine recommendations over a 5-year period [10]; however, a more recent report determined that 68% of an outpatient population had tried 3 or more antipsychotics before switching to clozapine [26]. In contrast, clozapine utilization in Australia appears to be more appropriate with a percentage as high as 51% of clozapine use in treatment-resistance schizophrenia [46].…”

Section: Clozapine Prescribing Trendsmentioning

confidence: 99%

“…However, none of the newer SGAs could demonstrate superiority to clozapine and in the last decade many published clinical practice guidelines [13][14][15][16][17][18][19][20] have recommended that clozapine be prescribed to patients with treatment-resistant schizophrenia, which has been defined as not responsive to two trials of any other antipsychotic medication (either FGA or SGA). Despite such recommendations and the overwhelming evidence of clozapine effectiveness, prescribing of clozapine appears to be low, delayed and often preceded by attempts at polypharmacy treatment, which lacks clinical evidence of effectiveness [21][22][23][24][25][26].…”

Section: Introductionmentioning

confidence: 99%

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A Case of Drug-Induced Acute Dyskinesia Treated with Korean Medicine

Lee¹,

Shin²,

Kim³

et al. 2017

J Int Korean Med

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Background: Clozapine effectiveness in the treatment of refractory schizophrenia has been sustained by published evidence in the last two decades, despite the introduction of safer options. Discussion: Current clinical practice guidelines have strongly recommended the use of clozapine in treatment-resistant schizophrenia, but prescribing trends do not appear to have followed such recommendations. Clozapine is still underutilized especially in patients at risk of suicide. It seems that physicians are hesitant in prescribing clozapine due to concerns about serious adverse effects. Recent reports have highlighted the need to inform health professionals about the benefits of treating patients with clozapine and have voiced concerns about the underutilization of clozapine especially in patients at risk of suicide. Summary: Guidelines and prescribing patterns reported in various countries worldwide are discussed. Suggestions on how to optimize clozapine utilization have been published but more efforts are needed to properly inform and support prescribers' practices.

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Clozapine Prescribing in a Canadian Outpatient Population

Cited by 30 publications

References 12 publications

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

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

Prescribing trends in treatment-resistant schizophrenia

A Case of Drug-Induced Acute Dyskinesia Treated with Korean Medicine

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