Myocarditis After Clozapine Initiation and mRNA SARS-CoV-2 Vaccination

Hansbauer, Maximilian; Fastantz, Enikö; Lutz, Justina; Hasan, Alkomiet

doi:10.1097/jcp.0000000000001577

Cited by 5 publications

(8 citation statements)

References 13 publications

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“…Severe complications such as myocarditis, presented in several case reports, 87,88 did not occur in patients treated with clozapine and vaccinated.…”

Section: Discussionmentioning

confidence: 90%

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Outcome of COVID-19 mRNA Vaccination in Patients Treated With Clozapine WHO Previously Went Through SARS-COV-2 Infection

Moga

Petric

Miron

et al. 2023

American Journal of Therapeutics

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Background: The outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic had multiple consequences for the health care system, especially for patients with mental illnesses. Schizophrenia patients particularly appear to have a higher risk of complications due to coronavirus-19 . Clozapine remains the gold standard for treatment-resistant schizophrenia (TRS). However, the COVID-19 pandemic had an important negative impact on clozapine treatment, mainly because of its administration protocol, which was very difficult to follow during the restrictions imposed in the pandemic, and its side effects in patients with COVID-19 infection. Vaccination is an effective method of avoiding SARS-CoV-2 infection or its severe complications, especially in susceptible populations. Data on adverse events after vaccination against COVID-19 are limited, both in the general population and in schizophrenia patients.Study Question: The study aimed to investigate the safety of COVID-19 vaccination in patients treated with clozapine for hematological parameters. Study Design:We conducted an analytical cross-sectional study between July 1, 2021, and June 30, 2022. We compared 2 groups of COVID-19 vaccinated patients who had previously experienced SARS-CoV-2 infection: The first group was treated with clozapine, whereas the second group was treated with other antipsychotics.Measures and outcomes: The primary objective was to identify granulocytopenia, leukocytopenia, and lymphocytopenia. The results were measured after the second dose of the Pfizer-BioNTech vaccine.

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“…Severe complications such as myocarditis, presented in several case reports, 87,88 did not occur in patients treated with clozapine and vaccinated.…”

Section: Discussionmentioning

confidence: 90%

“…36 These findings suggest that this effect is due to a general immune response, rather than a vaccine-specific reaction. 86 Severe complications such as myocarditis, presented in several case reports, 87,88 did not occur in patients treated with clozapine and vaccinated.…”

Section: Discussionmentioning

confidence: 96%

Outcome of COVID-19 mRNA Vaccination in Patients Treated With Clozapine WHO Previously Went Through SARS-COV-2 Infection

Moga

Petric

Miron

et al. 2023

American Journal of Therapeutics

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“…A total of 12 articles met the inclusion and exclusion criteria for this rapid review. Eight articles were case reports, [16][17][18][19][20][21][22][23] 3 were prospective observational studies, 5,24,25 and 1 was a cross-sectional study. 26 The PRISM diagram is included in the Supplementary Materials (Supplemental Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Myocarditis was suspected in one subject in a case report. 16 It developed after the second dose of the vaccine, but it was the first dose with overlap with clozapine. The subject experienced progressive tachycardia, chest pain, and elevated troponin levels, with no evidence of coronary artery disease on cardiac catheterization.…”

Section: Effects Of Covid-19 Vaccine Dosesmentioning

confidence: 99%

A Rapid Review of the Effects of the COVID-19 Vaccine Among Individuals Taking Clozapine

Das,

Sawyer,

Bagla

2024

J Clin Psychopharmacol

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Background The COVID-19 pandemic prompted the rapid development of vaccines to combat the virus. Several COVID-19 vaccines have proven effective in preventing infection, hospitalization, and death. Vaccination has been especially recommended for vulnerable populations, such as individuals with psychiatric illnesses who face increased risks due to comorbidities and socioeconomic factors. This rapid review identifies and analyzes the effects of COVID-19 vaccines among individuals taking clozapine. Methods The review included articles from PubMed, OVID, Clinical Key, Web of Science, and Google Scholar, published between September 2020 and December 2023. Inclusion criteria were peer-reviewed journals, English language, patients on clozapine receiving a COVID-19 vaccine, and documented vaccine-related adverse effects. Results Twelve articles were included, consisting of 8 case reports, 1 cross-sectional study, and 3 prospective observational studies, involving 298 subjects, with 9 subjects from case reports. After the first vaccine dose, 27 of 248 subjects experienced adverse effects, with 1 case report advising a temporary halt and dose reduction of clozapine. The subject in this case was admitted in a delirious state 4 days after vaccination with repeated falls and urinary incontinence; active infectious and neurologic etiologies were ruled out. Second dose data were available for 261 subjects, with 31 reporting adverse effects. Adverse effects included hematological changes, delirious state, seizures, and fever. Conclusions The review suggests that individuals on clozapine receiving COVID-19 vaccines may experience adverse effects. Clozapine levels and immune system interactions should be monitored in these cases.

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“…Given that both, clozapine and olanzapine, are substrates of the CYP1A2 enzyme [148,149], a pharmacokinetic interaction is conceivable. This is supported by the fact that both compounds are impacted by polycyclic aromatic hydrocarbons in cigarette smokea strong inducer of CYP1A2 [150][151][152]. Although there are some reports about olanzapine-induced myocarditis [137], compared to clozapine this risk appears to be considerably lower.…”

Section: Olanzapinementioning

confidence: 96%

When, Why and How to Re-challenge Clozapine following Myocarditis

Qubad¹,

Dupont²,

Hahn³

et al. 2023

Preprint

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Clozapine-induced myocarditis (CIM) is among the most important side-effects limiting the use of clozapine as the most effective treatment for schizophrenia and schizoaffective disorder. CIM necessitates immediate termination of clozapine, often resulting in its permanent discontinuation with considerable detrimental effects on patient’s psychopathology and long-term outcome. Consequently, a clozapine re-challenge after CIM has been discussed, with published reports indicating a success rate of approximately 60 %. However, compared to re-challenges after clozapine-induced neutropenia for CIM cases remain considerably more limited. Here, we provide a narrative review of the current state of research regarding the epidemiology, pathophysiology, risk factors, diagnosis, and clinical management of CIM. Moreover, we review current recommendations for re-challenging patients after CIM. We illustrate these issues using a case presentation with a special focus on the relevance of CRP, troponin, NT-proBNP, therapeutic drug-monitoring and cardiac MRI. Our review and case presentation underscore the importance of swiftly attempting to reinitiate clozapine after CIM given the lack of effective alternatives. Cardiac MRI might aid this strategy due to its high sensitivity for detecting myocardial inflammation. Moreover, both previous findings and our case indicate that using slow dose titration regimes and addressing other risk factors for CIM including concomitant valproate are crucial to ensure a safe and successful re-challenge.

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Myocarditis After Clozapine Initiation and mRNA SARS-CoV-2 Vaccination

Cited by 5 publications

References 13 publications

Outcome of COVID-19 mRNA Vaccination in Patients Treated With Clozapine WHO Previously Went Through SARS-COV-2 Infection

Outcome of COVID-19 mRNA Vaccination in Patients Treated With Clozapine WHO Previously Went Through SARS-COV-2 Infection

A Rapid Review of the Effects of the COVID-19 Vaccine Among Individuals Taking Clozapine

When, Why and How to Re-challenge Clozapine following Myocarditis

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