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.
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
[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.
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
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