Comparative effectiveness of antipsychotic treatment strategies for relapse prevention in first-episode schizophrenia in Finland: a population-based cohort study

The Lancet Psychiatry, Journal Year: 2025, Volume and Issue: 12(2), P. 122 - 130

Published: Jan. 22, 2025

The best pharmacological treatment practices for relapse prevention in patients with first-episode schizophrenia are unclear. We aimed to assess different strategies used before and after the first relapse, their associations subsequent risk. In this population-based cohort study, we enrolled individuals (aged ≤45 years) who were hospitalised subsequently relapsed between 1996 2014 from nationwide Finnish Hospital Discharge Register. Individuals had not been taking antipsychotics within year preceeding initial hospitalisation a 5 years of discharge included analyses. Treatment assessed during 30 days categorised as either long-acting injectable, clozapine, non-clozapine oral antipsychotic monotherapy, polypharmacy, non-use. Adjusted hazard ratios (aHRs) risk second based on type analysed Cox regression models 2 or until death end data linkage (Dec 31, 2017). People lived experience involved research writing process. Between Jan Dec 2017, 3000 psychosis eligible analysis. Mean age was 30·0 (SD 7·6), 1069 (35·6%) women 1931 (64·4%) men. No ethnicity available. 2148 (71·7%) years. Before most using (n=1366 [45·5%]), monotherapy (n=973 [32·4%]). Compared continuing same strategy switching clozapine associated lowest compared any (aHR 0·66, 95% CI 0·49-0·89; rate 73·2% continuation vs 57·1% switch clozapine). Switching another (0·99, 0·76-1·28) approximately unhelpful preventing next non-use (1·07, 0·80-1·42). having despite use antipsychotics, modality did show evidence being beneficial prevention, suggesting that should be started instead. This finding, together existing knowledge decreased mortality challenges current guidelines recommend third-line treatment, resulting characterised by long delays initiation. Sigrid Jusélius Foundation.

Language: Английский

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Letter to the FDA Proposing Major Changes in the US Clozapine Package Insert Supported by Clozapine Experts Worldwide. Part I

Journal of Clinical Psychopharmacology, Journal Year: 2025, Volume and Issue: unknown

Published: April 8, 2025

Abstract Purpose/Background Clozapine was approved in the United States (US) using 1989 regulations and knowledge. After 30 years, many sections of US package insert (PI) are outdated. Methods We comprehensively reviewed literature to propose PI updates. present information 2 articles. In Part I, we focus on basic pharmacology based 407 relevant II focuses clinical aspects pharmacovigilance. Findings/Results Based more recent expectations Food Drug Administration regulations, clozapine including following: 1) clearance, 2) pharmacokinetics pharmacodynamics, 3) monitoring tools. identified 9 major problems pharmacological vivo studies indicate that is dependent CYP1A2 for its metabolism, minor role CYP2D6 metabolism requires removing recommendation lower doses poor metabolizers, nontoxic concentrations CYP3A4 has a potent inhibitors lack clinically effects, 4) several drug-drug interactions need be updated literature, 5) systemic inflammation may decrease increase risk intoxication, 6) obesity 7) patients Asian Indigenous American ancestry doses, 8) personalized titration c-reactive protein should considered until prospective available, 9) half-life section needs modified acknowledge single dosing at night frequent US. Implications/Conclusions An improvement lead PIs worldwide.

Language: Английский

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Promoting safer and wider worldwide use of clozapine

Schizophrenia Research, Journal Year: 2024, Volume and Issue: unknown

Published: March 1, 2024

Language: Английский

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Clozapine may consistently protect from suicidal behaviors while other antipsychotics may lack a specific protective effect: a comprehensive VigiBase study interpreted in the context of the prior literature

Expert Opinion on Drug Safety, Journal Year: 2024, Volume and Issue: unknown, P. 1 - 11

Published: Sept. 3, 2024

Background In the United States clozapine was first approved for treatment-resistant schizophrenia and then suicidality in psychoses. Systematic reviews support clozapine's anti-suicidal effect, but forensic literature stresses its lethality during overdoses.

Language: Английский

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Identifying and managing treatment resistance early with the integration of a clozapine clinic within an early intervention for psychosis service

Early Intervention in Psychiatry, Journal Year: 2024, Volume and Issue: unknown

Published: May 23, 2024

Despite being the most effective antipsychotic medication for treatment-resistant psychosis, clozapine is often under-utilized with long delays to initiation.

Language: Английский

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Evaluating the adverse drug reactions to clozapine in populations of children and adolescents: insights from VigiBase data

European Child & Adolescent Psychiatry, Journal Year: 2024, Volume and Issue: unknown

Published: Dec. 2, 2024

Language: Английский

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A Case of Clozapine-Induced Hepatotoxicity: Management Considerations and Future Direction

Cureus, Journal Year: 2024, Volume and Issue: unknown

Published: Oct. 3, 2024

Clozapine is an atypical antipsychotic used for treatment-resistant schizophrenia. Its use often limited due to its well-known association with a variety of side effects. Hepatotoxicity less common effect and has been infrequently reported. Here, we present the case patient who developed abdominal discomfort right upper quadrant pain after clozapine was initiated. Liver transaminases were found be elevated continued rise despite cessation another psychiatric medication more commonly associated hepatotoxicity. Discontinuation resulted in relief symptoms normalization liver enzymes without any complications.

Language: Английский

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Response to clozapine and its predictors in treatment-resistant schizophrenia spectrum disorders: A retrospective chart review

Schizophrenia Research, Journal Year: 2024, Volume and Issue: 275, P. 179 - 188

Published: Dec. 31, 2024

Language: Английский

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