Abstract
Clozapine treatment remains the gold standard for treatment-resistant schizophrenia. This study aimed to describe temporal trends in clozapine use at discharge among patients with schizophrenia at two of the largest public psychiatric hospitals in Taiwan over a twelve-year period. Patients with schizophrenia discharged from the two study hospitals between 2006 and 2017 (n = 24,101) were included in the analysis. Antipsychotic augmentation was defined as concomitant use of a second antipsychotic as augmentation to clozapine treatment. Changes in the rate of clozapine use and antipsychotic augmentation at discharge over time were analyzed using the Cochran-Armitage trend test. Patients discharged on clozapine had significantly longer hospital stays than other patients. The rate of clozapine use at discharge increased from 13.8% to 20.0% over time (Z = 6.88, p < .0001). Concomitant use of anticholinergic medication was more common in patients receiving antipsychotic augmentation than clozapine antipsychotic monotherapy. Among patients discharged on clozapine, the rate of augmentation with a second antipsychotic increased from 19.1% to 36.2% over time (Z = 6.58, p < .0001). Among patients receiving antipsychotic augmentation, use of another second-generation antipsychotic as the augmentation agent grew from 32.6% to 65.5% over time (Z = 8.90, p < .0001). The increase in clozapine use was accompanied by an increase in concomitant use of a second antipsychotic as augmentation during the study period. Further studies are warranted to clarify the risk/benefit of this augmentation strategy. Clozapine may still be underutilized, and educational programs are needed to promote clinical use of clozapine.
Highlights
Many agree clozapine is by far the most effective treatment for T RS6–8
Not all patients with TRS will respond to clozapine antipsychotic monotherapy
It is estimated that approximately 40–70% of patients with TRS do not respond to clozapine antipsychotic monotherapy of adequate dose and duration[22,23]
Summary
Many agree clozapine is by far the most effective treatment for T RS6–8. Clozapine is often underused in patients with TRS despite its proven efficacy. Potential adverse effects, such as metabolic syndrome, bowel obstruction, agranulocytosis, pneumonia, and myocarditis may have limited its u se[13,14,15]. In the event of clozapine antipsychotic monotherapy failure, rates of augmentation with a second antipsychotic agent fluctuate from 18 to 44%26,27. The aim of this study was to illustrate the temporal trends in clozapine use and augmentation with a second antipsychotic to clozapine treatment at time of discharge among patients with schizophrenia discharged from two public psychiatric hospitals in Taiwan over a twelve-year period (2006–2017)
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