Clozapine rechallenge following neutropenia using granulocyte colony-stimulating factor: A Quebec case series

Béchard, Laurent; Corbeil, Olivier; Plante, M.; Thivierge, M. Carole; Lafrenière, Charles-Émile; Roy, Marc‐André; Demers, Marie-France

doi:10.1177/02698811211029737

Cited by 9 publications

(20 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although lithium stimulates leucocyte production, it may also mask the onset of agranulocytosis. Preliminary data suggest that granulocyte-colony stimulating factor, widely used to reduce the incidence and severity of chemotherapy-induced neutropenia, may be useful for stimulating leukopoiesis during clozapine rechallenge [ 120 – 123 ].…”

Section: Side Effect Monitoring and Managementmentioning

confidence: 99%

A Guideline and Checklist for Initiating and Managing Clozapine Treatment in Patients with Treatment-Resistant Schizophrenia

et al. 2022

View full text Add to dashboard Cite

Section: Side Effect Monitoring and Managementmentioning

confidence: 99%

A Guideline and Checklist for Initiating and Managing Clozapine Treatment in Patients with Treatment-Resistant Schizophrenia

et al. 2022

View full text Add to dashboard Cite

“…Finally, even though not adopted in the present case, granulocyte colony-stimulating factor has been used in previous similar cases. Although several reports have shown the effectiveness of granulocyte colony-stimulating factor administration to patients with clozapine-induced neutropenia, most are reports on rechallenges after clozapine-induced neutropenia 27 28…”

Section: Discussionmentioning

confidence: 99%

Combination of strategies to initiate clozapine for refractory schizophrenia in a patient with low neutrophil levels

et al. 2022

View full text Add to dashboard Cite

Clozapine is the only drug with confirmed efficacy for refractory schizophrenia; however, its use is restricted due to the risk of potentially life-threatening side effects, such as agranulocytosis. Although this restriction ensures safety against haematological risks, some patients with refractory schizophrenia who have low neutrophil levels may miss the opportunity to receive clozapine treatment. We herein report the case of a patient with refractory schizophrenia and low neutrophil levels who was successfully initiated on clozapine treatment after the use of several methods for increasing neutrophil levels. These strategies consisted of discontinuation of antipsychotics, treatment with lithium carbonate and adenine, and light exercise before blood testing. Combining these procedures may be an effective option in the treatment of patients with refractory schizophrenia whose neutrophil levels are not sufficient to initiate clozapine.

show abstract

“…Therefore, such a strategy has been proposed for patients where discontinuation of G-CSF results in recurrent neutropenia 310 . However, long-term safety and efficacy data are currently lacking 308,310,[312][313][314][315] .…”

Section: Re-challenge After Neutropeniamentioning

confidence: 99%

Second to None – Rationale, Timing, and Clinical Management of Clozapine Use in Schizophrenia

Qubad¹,

Bittner²

2022

Preprint

View full text Add to dashboard Cite

Despite its continued relevance as the single most effective and important evidence-based treatment for schizophrenia, the degree of underutilization of clozapine across health systems remains considerable. To a substantial degree, this is attributable to a reluctance of psychiatrists to use clozapine due to its relatively large side-effect burden and its comparatively complex dosing and monitoring requirements. This underscores the necessity for continued education of clinicians in the intricacies of clozapine use and in the still growing case in favor of this vital treatment option. Consequently, this narrative review provides a comprehensive outline of all lines of evidence, which support clozapine’s wide-ranging superior efficacy, and of the current knowledge regarding the prevalence and diagnosis of treatment resistance. The distinct neurobiological and clinical characteristics of this condition makes the swift initiation of clozapine indispensable. Moreover, we review the extensive literature regarding clozapine’s side effect profile and current recommendations for optimal treatment and monitoring algorithms including for particularly vulnerable populations such as elderly patients and pregnant women and for potential re-challenges after myocarditis and neutropenia. We also discuss established approaches to increase treatment response as well as augmentation strategies for patients with partial or full clozapine resistance. We argue for a clear focus on early and consistent detection and management of side effects, which can ensure patient safety and reduce permanent all-cause discontinuation. This strategy needs to be combined with a long-term approach acknowledging the late onset of clozapine’s full advantageous effects, which – in cases like reduced mortality rates – even then may not be easily discernible. Our aim is to encourage a safer, more frequent, and timely use of clozapine to maximize patients’ short- and long-term benefits. Even now, the extent of these benefits as well as patient’s satisfaction with treatment still clearly set clozapine apart from all other available treatment options.

show abstract

Clozapine rechallenge following neutropenia using granulocyte colony-stimulating factor: A Quebec case series

Cited by 9 publications

References 24 publications

A Guideline and Checklist for Initiating and Managing Clozapine Treatment in Patients with Treatment-Resistant Schizophrenia

A Guideline and Checklist for Initiating and Managing Clozapine Treatment in Patients with Treatment-Resistant Schizophrenia

Combination of strategies to initiate clozapine for refractory schizophrenia in a patient with low neutrophil levels

Second to None – Rationale, Timing, and Clinical Management of Clozapine Use in Schizophrenia

Contact Info

Product

Resources

About