Six Cases of Perforated Appendicitis During Clozapine Treatment

Steinert, Tilman; Jans, Franziska

doi:10.4088/jcp.20cr13841

Cited by 7 publications

(15 citation statements)

References 8 publications

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“…Incidentally, the incidence of appendicitis during clozapine administration in our study was slightly lower than that reported in a previous research [17]. One possible explanation for this is that approximately 30% of patients in the clozapine exposure group were transferred back to the referring hospital after the introduction of clozapine was completed; therefore, it was not possible to monitor the subsequent onset of appendicitis.…”

Section: Discussioncontrasting

confidence: 86%

“…One possible explanation for this is that approximately 30% of patients in the clozapine exposure group were transferred back to the referring hospital after the introduction of clozapine was completed; therefore, it was not possible to monitor the subsequent onset of appendicitis. In a previous study, age at the start of clozapine administration in patients taking clozapine was not mentioned [17].…”

Section: Discussionmentioning

confidence: 99%

“…Consistent with previous research, the proportion of laxative users was signi cantly higher in the clozapine-exposed group than in the non-clozapine-exposed group (86.2% vs. 29.0%, p < 0.001). Steinert et al, who rst reported the relationship between clozapine administration and appendicitis, also mentioned that two of six patients with appendicitis during clozapine administration exhibited subileus in the process of diagnosis [17]. Incidentally, constipation is a common side effect not only in clozapine users but also in other antipsychotic users.…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that if a patient with schizophrenia develops appendicitis, the awareness and detection of abdominal symptoms are delayed owing to less pain sensitivity, which often leads to more severe conditions such as perforated appendicitis [14][15][16]. Regarding the association between clozapine use and the onset of appendicitis, a single-center retrospective observational study in Germany found that the incidence of appendicitis was remarkably high (2, 726 cases per 100,000 person-years) in patients with schizophrenia treated with clozapine [17]. To the best of our knowledge, this study is the only one that referred to this relationship; however, an analysis of its causality and a comparison between the incidence of appendicitis in patients treated with clozapine versus those treated with other antipsychotics, excluding clozapine, has not been performed.…”

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confidence: 99%

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Relationship between clozapine exposure and the onset of appendicitis in schizophrenia patients: a retrospective cohort study

Kawakita

Takeshima

Komatsu

et al. 2022

Preprint

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Objective:Clozapine may cause serious side effects despite benefits in patients with schizophrenia. Thus, an accurate understanding of the side-effect profile of clozapine is extremely important in the management of its administration to patients with schizophrenia. Our aim was to validate the relationship between clozapine exposure and appendicitis onset in patients with schizophrenia.Methods:In this study, we retrospectively compared the incidence and cumulative incidence of appendicitis in patients with schizophrenia with and without a history of clozapine exposure. Among the patients with schizophrenia who visited our hospital between June 2009 and August 2021, we extracted those with a history of clozapine treatment. Patients with a history of taking clozapine were defined as the clozapine exposure group, while the others were defined as the clozapine non-exposure group. Patients with a history of appendectomy or clozapine use at other hospitals were excluded. Results:There were 65 patients in the clozapine exposure group and 400 patients in the clozapine non-exposure group who met the inclusion criteria. The exposure group exhibited a remarkably higher incidence of appendicitis during the observation period than the non-exposure group (863 cases vs. 124 cases per 100,000 person-years). In particular, if limited to the period of clozapine exposure, the incidence of appendicitis is extremely high, at 2,086 cases per 100,000 person-years. Moreover, the multivariable analysis showed that clozapine exposure during adolescence is a risk factor for appendicitis onset.Conclusions:Clozapine exposure is associated with appendicitis onset in patients with schizophrenia.

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Section: Discussioncontrasting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Relationship between clozapine exposure and the onset of appendicitis in schizophrenia patients: a retrospective cohort study

Kawakita

Takeshima

Komatsu

et al. 2022

Preprint

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“…It has been reported that if a patient with schizophrenia develops appendicitis, the awareness and detection of abdominal symptoms are delayed owing to less pain sensitivity, which often leads to more severe conditions such as perforated appendicitis [ 15 – 17 ]. Regarding the association between clozapine use and the onset of appendicitis, a single-center retrospective observational study in Germany found that the incidence of appendicitis was remarkably high (2,726 cases per 100,000 person-years) in patients with schizophrenia treated with clozapine [ 18 ]. To the best of our knowledge, this study is the only one that referred to this relationship; however, it did not adequately provide a statistical verification of whether clozapine exposure is a risk factor for appendicitis onset among patients with schizophrenia.…”

Section: Introductionmentioning

confidence: 99%

Relationship between clozapine exposure and the onset of appendicitis in schizophrenia patients: a retrospective cohort study

Kawakita

Takeshima

Komatsu³

et al. 2022

BMC Psychiatry

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Objective Clozapine may cause serious side effects despite benefits in patients with schizophrenia. Thus, an accurate understanding of the side-effect profile of clozapine is extremely important in the management of its administration to patients with schizophrenia. Our aim was to validate the relationship between clozapine exposure and appendicitis onset in patients with schizophrenia. Methods In this study, we retrospectively compared the incidence and cumulative incidence of appendicitis in patients with schizophrenia with and without a history of clozapine exposure. Among the patients with schizophrenia who visited our hospital between June 2009 and August 2021, we extracted those with a history of clozapine treatment. Patients with a history of taking clozapine were defined as the clozapine exposure group, while the others were defined as the clozapine non-exposure group. Patients with a history of appendectomy before their initial visit to our hospital or with a history of clozapine use at other hospitals were excluded. Results There were 65 patients in the clozapine exposure group and 400 patients in the clozapine non-exposure group who met the inclusion criteria. The exposure group exhibited a remarkably higher incidence of appendicitis during the observation period than the non-exposure group (863 cases vs. 124 cases per 100,000 person-years). In particular, if limited to the period of clozapine exposure, the incidence of appendicitis is extremely high, at 2,086 cases per 100,000 person-years. Moreover, multivariable analysis showed that clozapine exposure was an independent factor contributing to the onset of appendicitis. Conclusions Clozapine exposure is associated with appendicitis onset in patients with schizophrenia.

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2022

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Six Cases of Perforated Appendicitis During Clozapine Treatment

Cited by 7 publications

References 8 publications

Relationship between clozapine exposure and the onset of appendicitis in schizophrenia patients: a retrospective cohort study

Relationship between clozapine exposure and the onset of appendicitis in schizophrenia patients: a retrospective cohort study

Relationship between clozapine exposure and the onset of appendicitis in schizophrenia patients: a retrospective cohort study

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