Predictors and markers of clozapine response

Chung, Carmen; Remington, Gary

doi:10.1007/s00213-005-2174-x

Cited by 39 publications

(34 citation statements)

References 153 publications

(197 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Can we isolate markers that will allow clinicians to better identify people who will respond to clozapine or, conversely, be at risk of particular side effects. While such work is already in place, [87][88][89][90][91] its priority is underscored by clozapine's unique profile even among other SGAs.…”

Section: Clozapine Circa 2009mentioning

confidence: 99%

Where to Position Clozapine: Re-Examining the Evidence

et al. 2010

Self Cite

View full text Add to dashboard Cite

Objective: To review clozapine's position in treatment algorithms for schizophrenia.Method: Clozapine's status is reviewed in the context of its initial discovery and unique clinical and (or) pharmacological profile, withdrawal and link with hematologic concerns, reintroduction with monitoring guidelines, prototype for atypicality, positioning in treatment algorithms, and current evidence regarding efficacy, effectiveness, and side effects. Results:The hematologic monitoring implemented with clozapine's reintroduction here in North America has proven successful in preventing clozapine-related deaths secondary to agranulocytosis. While its other side effects are not without concern, present evidence does not link clozapine to increased mortality rates; indeed, it appears better than other antipsychotics in this regard. Moreover, its clinical superiority compared with all other antipsychotics has been confirmed both in efficacy and in effectiveness trials.Conclusions: Schizophrenia continues to represent a treatment challenge, with many people demonstrating suboptimal response and poor functional outcome. Clozapine is routinely positioned as a third-line treatment in schizophrenia, but in light of existing evidence this warrants re-examination.Can J Psychiatry. 2010;55(10):677-684. Clinical Implications· Although clozapine has demonstrated superiority to other antipsychotics in refractory schizophrenia, it remains underprescribed and delayed in its use.· A large body of recent data, in combination with current safety measures, confirms that clozapine-induced agranulocytosis and related deaths are very rare.· Clozapine's unique clinical profile in refractory schizophrenia challenges delayed access to its use. Limitations· The data in this review are relevant and applicable only in the countries where clozapine safety measures are in place. · Clozapine's clinical superiority appears specific to refractory schizophrenia. · Use of clozapine earlier than third-line treatment requires a re-evaluation of how refractory schizophrenia is currently defined.

show abstract

Section: Clozapine Circa 2009mentioning

confidence: 99%

Where to Position Clozapine: Re-Examining the Evidence

et al. 2010

Self Cite

View full text Add to dashboard Cite

show abstract

“…Caution is in order since these levels are lowered by nicotine. 22 However, Potkin et al observed that around 30% of non-responders achieved plasma levels above the supposed adequate threshold.…”

mentioning

confidence: 99%

“…22 Although studies are not unanimous, plasma levels equal to or greater than 350 ηg/ml reaching 500 ηg/ml tend to be associated with a satisfactory clinical response. Caution is in order since these levels are lowered by nicotine.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Esquizofrenia refratária

Elkis

Meltzer

2007

Rev. Bras. Psiquiatr.

View full text Add to dashboard Cite

A b s t r a c t Objective: The aim of the present paper is to review the various aspects of refractory schizophrenia regarding issues such as definitions, clinical aspects, psychobiological correlates, pharmacological and non-pharmacological treatment options and predictors of treatment response. Method: Medline search as well as articles of the authors. Results and Conclusions: Refractory schizophrenia affects at least one third of patients with schizophrenia and the best evidence shows that is monotherapy with clozapine remains the mainstay for the treatment of such condition. Antipsychotic polipharmacy is not supported by current evidence and recent clinical trials have shown that clozapine augmentation with antipsychotics has no benefit over placebo.Descriptors: Schizophrenia/therapy; Drug utilization review; Clinical protocols; Pharmacologic actions; Treatment outcome Resumo Objetivo: O propósito deste artigo é o de revisar vários aspectos da esquizofrenia refratária levando em conta questões relacionadas a definição, aspectos clínicos, correlatos psicobiológicos, tratamentos farmacológicos e não farmacológicos, assim como preditores de resposta terapêutica. Método: Pesquisa no Medline, assim como artigos dos autores. Resultados e Conclusões: Pelo menos um terço dos pacientes com esquizofrenia são refratários a tratamento com antipsicóticos e as evidências apontam a clozapina em monoterapia como a principal opção nesses casos. A politerapia com antipsicóticos não tem apoio em evidências. Ensaios clínicos recentes mostraram que a potencialização da clozapina com outros antipsicóticos não é superior ao placebo.

show abstract

“…However, treatment with clozapine is associated with several side effects that complicate the use of the drug and necessitate therapeutic monitoring [1,2]. This monitoring allows the optimization of the therapeutic dose-response efficacy and the prevention of excessive toxicity of CZ, reducing in this way the risk of relapse [3][4][5]. Despite the effectiveness of clozapine as a standard drug for schizophrenia-treatment resistance, important individual variations in the response to clozapine therapy were reported [6,7].…”

Section: Introductionmentioning

confidence: 99%

Relationships between clozapine and norclozapine plasma concentrations, clozapine dose, and clinical response in Tunisian patients with schizophrenia-treatment resistance

Taieb¹,

B’chir²,

Molinié³

et al. 2012

OJPsych

View full text Add to dashboard Cite

The present study investigated relationships between clozapine dose, clozapine and norclozapine plasma concentrations, and clinical responses to clozapine treatment in Tunisian schizophrenics. Fourteen schizophrenia-treatment resistant patients, recruited for this study, were treated with clozapine for 45 days. Patient health improvement was assessed before and after each cycle of two weeks of clozapine therapy, using the Brief Psychiatric Rating Scale (BPRS). Plasma clozapine and norclozapine concentrations were determined by high-performance liquid chromatography (HPLC). No significant correlations between plasma clozapine and norclozapine concentrations and clinical health improvement among our schizophrenic patients were found. However, a significant correlation was observed between clinical health improvement given by BPRS scores and norclozapine plasma concentration to daily clozapine dose ratio (NCZ/D). Despite the small sample size of our study, our findings suggest that the clozapine therapy response variations observed in our patients may be, in part, explained by the interindividual differences in plasma norclozapine concentration to clozapine dose ratio (NCZ/D). So the NCZ/D parameter could be used as a good indicator for adjusting the clozapine dose-adaptation strategy and consequently for improving the clinical psychopathological state of schizophrenia-treatment resistant patients.

show abstract

Predictors and markers of clozapine response

Cited by 39 publications

References 153 publications

Where to Position Clozapine: Re-Examining the Evidence

Where to Position Clozapine: Re-Examining the Evidence

Esquizofrenia refratária

Relationships between clozapine and norclozapine plasma concentrations, clozapine dose, and clinical response in Tunisian patients with schizophrenia-treatment resistance

Contact Info

Product

Resources

About