Clozapine recent abstracts

In the December 2016 issue of JPR we feature recent abstracts relating to Clozapine.

The first abstract is from a group in Brisbane Australia who found that Clozapine is superior for the treatment of positive symptoms in refractory schizophrenia. Number needed to treat was 9 and number need to harm ranged between 4 and 19. months. However the authors suggest that if there is no improvement in symptoms or function after 6 months than a switch to an alternate antipsychotic should be considered.

The second abstract comes from Munich Germany and concerns the emergence of obsessive compulsive symptoms in assocaition with antipsychotic prescription.

 

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Clozapine v. first- and second-generation antipsychotics in treatment-refractory

schizophrenia: systematic review and meta-analysis.

Siskind D, McCartney L, Goldschlager R, Kisely S.

Br J Psychiatry. 2016 Nov;209(5):385-392. Epub 2016 Jul 7.

 

BACKGROUND: Although clozapine is the ‘gold standard’ for treatment-refractory

schizophrenia, meta-analyses of clozapine for this condition are lacking.

AIMS:  The authors conducted a systematic review and meta-analysis of clozapine treatment

for people with treatment-refractory schizophrenia.

METHOD: Search of the Cochrane Schizophrenia Group’s trial register, PubMed and

EMBASE and hand-searched key papers for randomised controlled trials of clozapine

for treatment-refractory schizophrenia.

RESULTS: Twenty-one papers with 25 comparisons were included. The number needed

to treat was 9. Clozapine was superior for positive symptoms in both the short

and long term. In the short term only clozapine was superior for total and

negative symptoms, with higher response rates. Both funding source and dosage

affected results. Higher baseline psychosis scores predicted better outcomes for

clozapine in a meta-regression.

CONCLUSIONS: Clozapine is superior for treatment-refractory disorder but if there

is no response by 6 months medications with lower adverse reactions should be

considered.

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[Obsessive-Compulsive Symptoms in a Sample of Patients with Chronic Schizophrenia

Under Clozapine Treatment].

 

[Article in German]

 

Schreiter S, Hasan A, Majic T, Wullschleger A, Schouler-Ocak M,

Bermpohl F, Gutwinski S.

Fortschr Neurol Psychiatr. 2016 Nov;84(11):675-681. Epub 2016 Nov 15.

 

Background: There is a high prevalence of obsessive-compulsive symptoms (OCS) in

patients with schizophrenia. Antipsychotic treatment, especially duration and

type of substance, is suspected to increase or even cause OCS.

Methods:

The authors examined in a naturalistic cross-sectional study the severity of OCS

(Obsessive-Compulsive Inventory – Revised) and the incidence of

obsessive-compulsive disorder (OCD) according to ICD-10 criteria in 70 patients

with schizophrenia. 26 patients were treated with clozapine and 44 patients were

treated with another second-generation antipsychotic (SGA). After group matching,

the two groups did not differ significantly in age, gender, duration of illness,

treatment duration with the current antipsychotic substance and

chlorpromazine-equivalent dosage.

 

Results: Patients treated with Clozapine showed

a significantly higher rate of OCD (χ(2) = 7.304, p = 0.007) and a significantly

higher severity of OCS (t = 2.216, p = 0.037) compared to patients treated with

another SGA. For the whole sample, duration of treatment with the current

antipsychotic medication correlated significantly (p = 0.033, r = 0.323) with the

severity of OCS, controlled for duration of illness. However, there was no

significant correlation between severity of OCS and duration of illness,

controlled for duration of treatment with the current antipsychotic substance.

 

Discussion: Our data suggest an interrelation between the development of OCS or

OCD and antipsychotic treatment, especially clozapine. Thereby, duration of

treatment is correlated with the severity of OCS, irrespective of the duration of

illness.