Incidence and outcome of COVID-19 in patients with schizophrenia: A Study from India

Grover, Sandeep; Kathiravan, Sanjana; Suman, Aarzoo; Naskar, Chandrima; Mehra, Aseem; Chakrabarti, Subho

doi:10.1016/j.schres.2021.08.002

Cited by 4 publications

(4 citation statements)

References 9 publications

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“…The evidence for potential anti‐SARS‐CoV‐2 effects of clozapine is unsatisfactory due to contradictory results. No negative effects of clozapine were shown in three studies with small numbers of clozapine users 10–12 . In a German retrospective inpatient study of the possible effects of psychiatric and somatic medication on the duration and severity of COVID‐19 ( n = 96), four patients who used clozapine (4.2%) all survived 10 .…”

Section: Introductionmentioning

confidence: 96%

“…No negative effects of clozapine were shown in three studies with small numbers of clozapine users. 10 , 11 , 12 In a German retrospective inpatient study of the possible effects of psychiatric and somatic medication on the duration and severity of COVID‐19 ( n = 96), four patients who used clozapine (4.2%) all survived. 10 In an Indian study of 594 ambulatory SSD patients of whom 356 received clozapine, no difference in incidence of COVID‐19 was found between patients receiving clozapine ( n = 23) and those receiving other antipsychotic medication ( n = 9).…”

Section: Introductionmentioning

confidence: 99%

“… 10 In an Indian study of 594 ambulatory SSD patients of whom 356 received clozapine, no difference in incidence of COVID‐19 was found between patients receiving clozapine ( n = 23) and those receiving other antipsychotic medication ( n = 9). 11 Unfortunately, a control group was lacking. Clozapine showed protective effects for infection and the course of disease in a small case‐control study ( n = 142) in Argentina with 60% less SARS‐CoV‐2 infection in clozapine users ( n = 13) compared with non‐clozapine users ( n = 102) and with the disease being only half as symptomatic in patients using clozapine as in patients on other medication (69.2% vs. 30.6%).…”

Section: Introductionmentioning

confidence: 99%

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Clozapine and COVID‐19 Vaccination: Effects on blood levels and leukocytes. An observational cohort study

Veerman

Moscou

Bogers

et al. 2022

Acta Psychiatr Scand

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Objective To investigate the safety of COVID‐19 vaccination in patients on clozapine as regards plasma clozapine concentration and haematological parameters. Methods We conducted a multicentre observational cohort study from 22 February 2021 to 2 September 2021. Primary outcomes were clinically relevant increase in clozapine blood levels (>100 μg/L increase compared to baseline) and clozapine alert levels (>1000 μg/L). Secondary outcomes were granulocytopenia, leukocytopenia and lymphocytopenia. Outcomes were measured approximately 5 days after the first and (where applicable) second dose of COVID‐19 vaccine. Results This study included 139 patients. Compared to baseline, clozapine blood levels increased significantly (ES = 0.28, p = 0.003) after the second vaccination. Clinically relevant increases in clozapine blood levels occurred in 20/92 patients (22%) and in 16/56 patients (29%) during the first and second phases, respectively. Clozapine alert levels developed in one patient (1%) following the first dose and in three patients (5%) after the second dose. In both phases, changes in white blood cells (WBC) were limited to mild granulocytopenia (3% and 5%), moderate granulocytopenia (1% and 0%) and leukocytopenia (2% and 3%) without cause for extra monitoring according to the guideline. Conclusion In general, as regards WBC counts COVID‐19 vaccination seems to be safe in patients with SMI. Changes in WBC had no clinical implications. Psychoeducation on the symptoms of clozapine intoxication is recommended, especially in patients with clozapine blood levels approaching the upper limit of the therapeutic range. Increase in the C‐reactive protein (CRP) level can signal inflammation rapidly and help to prevent clozapine intoxication following vaccination.

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Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clozapine and COVID‐19 Vaccination: Effects on blood levels and leukocytes. An observational cohort study

Veerman

Moscou

Bogers

et al. 2022

Acta Psychiatr Scand

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“…Since the publication of our meta-analysis, the Center for Disease Control and Prevention (CDC) updated its list of conditions associated with severe COVID-19, including schizophrenia. The increased COVID-19 mortality in schizophrenia-spectrum disorders was confirmed in other countries [17][18][19] and synthetized in a meta-analysis published in 2022 confirming that schizophrenia was a risk factor for both contracting COVID-19 infection and developing a severe/lethal form of the infection [20 && ]. In this meta-analysis, 263 207 patients from 10 studies were included and the relative risk ratio of increased mortality was 2.2 (1.54-3.20).…”

Section: Increased Risk Of Infection and Increased Mortalitymentioning

confidence: 85%

Lessons from the coronavirus disease 2019 pandemic in schizophrenia: a review

Fond

Boyer

2023

Current Opinion in Psychiatry

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Purpose of reviewMultiple countries have reported increased COVID-19 mortality in patients with schizophrenia. The purpose of this review was to synthetize the consequences of the pandemic on patients with schizophrenia including vaccination data.Recent findingsWe have synthetized data on the increased risk of infection and increased mortality, the impact of the pandemic and lockdowns on psychiatric care, vaccination policies, unwillingness to vaccine in patients and the rates of vaccination.SummarySchizophrenia has been confirmed at increased risk of both COVID-19 infection and developing a severe/lethal form of the infection. Patients with schizophrenia should, therefore, be prioritized for vaccination whenever possible and should be prioritized for psychiatric and somatic care access. Psychotic symptomatology may be a barrier to vaccination in some patients, and heterogenous vaccination rates were identified in national databases. The COVID-19 pandemic has been also a unique opportunity to develop telehealth. A mixed face-to-face and distance model should be encouraged, whenever possible, to improve the experience of patients, relatives and healthcare professionals. No major change of long-acting antipsychotics has been reported in most countries, and there was no consistent evidence for clozapine prescription to increase the risk of COVID-19 infection or severe outcomes.

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Clozapine Therapy and COVID-19: A Systematic Review of the Prevalence Rates, Health Outcomes, Hematological Markers, and Patient Perspectives

Giles

Varghese

Shymko

et al. 2022

Schizophrenia Bulletin

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Background/Objectives There have been concerns that clozapine treatment may undermine the capacity of the body to fight infection and increase the vulnerability to contracting COVID-19. This review of recent cohort studies investigated (1) whether people with a severe psychiatric disorder are at increased risk of COVID-19 and complications, (2) the immunological response of clozapine-users who contract COVID-19, and (3) patients’ perspectives on COVID-19 and the pandemic response. Methods A systematic search of EMBASE, Medline, Pubmed, and PsycINFO databases using PRISMA guidelines using “COVID-19”, “clozapine”, and “vaccination” terms. Results 18 studies (out of 330 identified) met all criteria (N = 119 054 including 8045 on clozapine). There was no strong evidence that clozapine users may be at increased risk of contracting COVID-19 or developing complications after adjusting for medical comorbidities. Hematological studies showed temporary reductions in neutrophils in COVID-19-positive patients and vaccination suggesting a clozapine effect in defence against infection. Vaccination studies did not report major adverse effects. Increased plasma levels of clozapine and neutropenia however point to COVID-19-related interference of clozapine metabolism. Patient surveys reported limited impact on mental health and positive attitudes regarding pandemic response. Conclusion This review did not find compelling evidence that the immune system of clozapine users put them at risk of COVID-19 and further complications. Evidence of drug–infection interactions however points to the importance of adhering to consensus guidelines about clozapine therapy during the pandemic. More evidence using longitudinal designs is required to examine the longer-term effects of COVID-19 and vaccination in this vulnerable population.

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Incidence and outcome of COVID-19 in patients with schizophrenia: A Study from India

Cited by 4 publications

References 9 publications

Clozapine and COVID‐19 Vaccination: Effects on blood levels and leukocytes. An observational cohort study

Clozapine and COVID‐19 Vaccination: Effects on blood levels and leukocytes. An observational cohort study

Lessons from the coronavirus disease 2019 pandemic in schizophrenia: a review

Clozapine Therapy and COVID-19: A Systematic Review of the Prevalence Rates, Health Outcomes, Hematological Markers, and Patient Perspectives

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