Comparative effectiveness of antipsychotic treatment strategies for relapse prevention in first-episode schizophrenia in Finland: a population-based cohort study
The Lancet Psychiatry,
Год журнала:
2025,
Номер
12(2), С. 122 - 130
Опубликована: Янв. 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.
Язык: Английский
Promoting safer and wider worldwide use of clozapine
Schizophrenia Research,
Год журнала:
2024,
Номер
unknown
Опубликована: Март 1, 2024
Язык: Английский
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,
Год журнала:
2024,
Номер
unknown, С. 1 - 11
Опубликована: Сен. 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.
Язык: Английский
Letter to the FDA Proposing Major Changes in the US Clozapine Package Insert Supported by Clozapine Experts Worldwide. Part I
Journal of Clinical Psychopharmacology,
Год журнала:
2025,
Номер
unknown
Опубликована: Апрель 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.
Язык: Английский
Identifying and managing treatment resistance early with the integration of a clozapine clinic within an early intervention for psychosis service
Early Intervention in Psychiatry,
Год журнала:
2024,
Номер
unknown
Опубликована: Май 23, 2024
Despite
being
the
most
effective
antipsychotic
medication
for
treatment-resistant
psychosis,
clozapine
is
often
under-utilized
with
long
delays
to
initiation.
Язык: Английский
Evaluating the adverse drug reactions to clozapine in populations of children and adolescents: insights from VigiBase data
European Child & Adolescent Psychiatry,
Год журнала:
2024,
Номер
unknown
Опубликована: Дек. 2, 2024
Язык: Английский
Response to clozapine and its predictors in treatment-resistant schizophrenia spectrum disorders: A retrospective chart review
Schizophrenia Research,
Год журнала:
2024,
Номер
275, С. 179 - 188
Опубликована: Дек. 31, 2024
Язык: Английский
A Case of Clozapine-Induced Hepatotoxicity: Management Considerations and Future Direction
Matthew B Bulkley,
Kendahl Oberdorfer,
Renee R Maan
и другие.
Cureus,
Год журнала:
2024,
Номер
unknown
Опубликована: Окт. 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.
Язык: Английский