Prior Antipsychotic Prescribing in Patients Currently Receiving Clozapine

Taylor, David; Young, Corina; Paton, Carol

doi:10.4088/jcp.v64n0107

Cited by 179 publications

(120 citation statements)

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“…In contrast, the situation for clozapine use differs because it is indicated for treatment-resistant schizophrenia and reserved for the most severely ill, refractory patients (Nielsen et al, 2009;Taylor et al, 2003), which can affect the risk for diabetes through perhaps even poorer healthy lifestyle behaviors than is common in schizophrenia patients in general (Sharpe et al, 2006). Furthermore, the superior efficacy of clozapine in treatment refractory patients (Kane et al, 1988) indicates that the increased diabetes risk has to be balanced with the chance for enhanced efficacy.…”

Section: Discussionmentioning

confidence: 99%

Antipsychotics Associated with the Development of Type 2 Diabetes in Antipsychotic-Naïve Schizophrenia Patients

Nielsen¹,

Skadhede²,

Correll³

2010

Neuropsychopharmacol

188

137

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Section: Discussionmentioning

confidence: 99%

Antipsychotics Associated with the Development of Type 2 Diabetes in Antipsychotic-Naïve Schizophrenia Patients

Nielsen¹,

Skadhede²,

Correll³

2010

Neuropsychopharmacol

188

137

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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%

“…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%

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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“…[2][3][4][5] The therapeutic response to atypical antipsychotics may differ from patient to patient, so psychiatrists and their patients may have to test multiple drugs and dosage levels to attain the desired clinical outcome, with continuity of the medication regimen the expressed goal. [6][7][8][9] Coverage of atypical antipsychotics is often restricted by health plan formularies in an effort to contain costs. 1,2 Such restrictions may yield a false economy, as use of atypical antipsychotics is correlated with enhanced concordance and lower hospitalization rates.…”

mentioning

confidence: 99%

Coverage of Atypical Antipsychotics Among Medicare Drug Plans in the State of Washington for Fiscal Year 2007

Wang¹,

Kennedy²,

Cohen³

et al. 2008

Prim. Care Companion J. Clin. Psychiatry

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Results: Almost all plans covered the 6 atypical antipsychotics. The PDPs were more likely to restrict coverage than the MAPDs. Prior authorization requirements were enforced in 5% to 21% of plans, depending on plan type and medication. Monthly drug plan premiums were higher for PDPs than MAPDs, but the MAPDs had concurrent monthly health premiums. About 80% of MAPDs and 60% of PDPs also had no annual deductible for medications. The patient out-ofpocket cost for atypical antipsychotics varied depending on the stage of coverage-median monthly drug costs ranged from $5 to $50 during the initial period, but if costs exceeded the annual cap, patients were responsible for the full cost of the drug, which ranged from $292 to $665. Patients with low incomes and those who exceeded the annual spending limit ($3850 in fiscal year 2007) had a median monthly cost of $17 to $33.Conclusion: There is considerable variation across health plans in terms of patients' out-ofpocket drug costs. Given the significant needs and vulnerabilities of Medicare beneficiaries with mental illness, changes for atypical antipsychotic coverage should be monitored carefully, and the complexity of Medicare drug plans should be minimized.

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Prior Antipsychotic Prescribing in Patients Currently Receiving Clozapine

Cited by 179 publications

References 0 publications

Antipsychotics Associated with the Development of Type 2 Diabetes in Antipsychotic-Naïve Schizophrenia Patients

Antipsychotics Associated with the Development of Type 2 Diabetes in Antipsychotic-Naïve Schizophrenia Patients

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

Coverage of Atypical Antipsychotics Among Medicare Drug Plans in the State of Washington for Fiscal Year 2007

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