Clozapine Treatment Is Associated With Higher Prescription Rate of Antipsychotic Monotherapy and Lower Prescription Rate of Other Concomitant Psychotropics: A Real-World Nationwide Study.
EGUIDE
Treatment-resistant schizophrenia
guideline
lithium
polypharmacy
Journal
The international journal of neuropsychopharmacology
ISSN: 1469-5111
Titre abrégé: Int J Neuropsychopharmacol
Pays: England
ID NLM: 9815893
Informations de publication
Date de publication:
25 10 2022
25 10 2022
Historique:
received:
30
03
2022
revised:
18
05
2022
accepted:
15
06
2022
pubmed:
21
6
2022
medline:
27
10
2022
entrez:
20
6
2022
Statut:
ppublish
Résumé
Although clozapine is effective for treatment-resistant schizophrenia (TRS), the rate of clozapine prescription is still low. Whereas antipsychotic monotherapy is recommended in clinical practice guidelines, the rate of antipsychotic polypharmacy is still high. There is little evidence on whether a clozapine prescription influences changes in the rate of monotherapy and polypharmacy, including antipsychotics and other psychotropics. We therefore hypothesized that the rate of antipsychotic monotherapy in patients with TRS who were prescribed clozapine would be higher than that in patients with schizophrenia who were not prescribed clozapine. We assessed 8306 patients with schizophrenia nationwide from 178 institutions in Japan from 2016 to 2019. We analyzed the psychotropic prescription data at discharge in patients diagnosed with TRS and with no description of TRS (ND-TRS) based on the diagnosis listed in the discharge summary. The rate of antipsychotic monotherapy in the TRS with clozapine group (91.3%) was significantly higher than that in the TRS without clozapine group (45.9%; P < 2.0 × 10-16) and the ND-TRS without clozapine group (54.7%; P < 2.0 × 10-16). The rate of antipsychotic monotherapy without any other concomitant psychotropics in the TRS with clozapine group (26.5%) was significantly higher than that in the TRS without clozapine group (12.6%; P = 1.1 × 10-6) and the ND-TRS without clozapine group (17.0%; P = 5.9 × 10-6). Clozapine prescription could be associated with a high rate of antipsychotic monotherapy. Patients will benefit from the correct diagnosis of TRS and thus from proper clozapine prescription.
Sections du résumé
BACKGROUND
Although clozapine is effective for treatment-resistant schizophrenia (TRS), the rate of clozapine prescription is still low. Whereas antipsychotic monotherapy is recommended in clinical practice guidelines, the rate of antipsychotic polypharmacy is still high. There is little evidence on whether a clozapine prescription influences changes in the rate of monotherapy and polypharmacy, including antipsychotics and other psychotropics. We therefore hypothesized that the rate of antipsychotic monotherapy in patients with TRS who were prescribed clozapine would be higher than that in patients with schizophrenia who were not prescribed clozapine.
METHODS
We assessed 8306 patients with schizophrenia nationwide from 178 institutions in Japan from 2016 to 2019. We analyzed the psychotropic prescription data at discharge in patients diagnosed with TRS and with no description of TRS (ND-TRS) based on the diagnosis listed in the discharge summary.
RESULTS
The rate of antipsychotic monotherapy in the TRS with clozapine group (91.3%) was significantly higher than that in the TRS without clozapine group (45.9%; P < 2.0 × 10-16) and the ND-TRS without clozapine group (54.7%; P < 2.0 × 10-16). The rate of antipsychotic monotherapy without any other concomitant psychotropics in the TRS with clozapine group (26.5%) was significantly higher than that in the TRS without clozapine group (12.6%; P = 1.1 × 10-6) and the ND-TRS without clozapine group (17.0%; P = 5.9 × 10-6).
CONCLUSIONS
Clozapine prescription could be associated with a high rate of antipsychotic monotherapy. Patients will benefit from the correct diagnosis of TRS and thus from proper clozapine prescription.
Identifiants
pubmed: 35723038
pii: 6611570
doi: 10.1093/ijnp/pyac036
pmc: PMC9593218
doi:
Substances chimiques
Clozapine
J60AR2IKIC
Antipsychotic Agents
0
Psychotropic Drugs
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
818-826Informations de copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of CINP.
Références
Ther Adv Psychopharmacol. 2016 Feb;6(1):33-8
pubmed: 26913176
Aust N Z J Psychiatry. 2016 May;50(5):410-72
pubmed: 27106681
J Psychopharmacol. 2019 Oct;33(10):1248-1253
pubmed: 31241396
Ann Clin Psychiatry. 2001 Dec;13(4):233-7
pubmed: 11958365
Neuropsychopharmacol Rep. 2022 Mar;42(1):3-9
pubmed: 34854260
Br J Psychiatry. 2016 Nov;209(5):385-392
pubmed: 27388573
Schizophr Bull. 2019 Mar 7;45(2):315-329
pubmed: 29697804
J Clin Psychiatry. 2019 Mar 5;80(2):
pubmed: 30840788
World Psychiatry. 2017 Feb;16(1):77-89
pubmed: 28127934
Neuropsychopharmacol Rep. 2021 Sep;41(3):266-324
pubmed: 34390232
BMC Res Notes. 2014 Sep 12;7:635
pubmed: 25214394
Pharmacopsychiatry. 2022 Mar;55(2):73-86
pubmed: 34911124
Psychiatry Clin Neurosci. 2019 Oct;73(10):642-648
pubmed: 31437336
J Clin Psychopharmacol. 2018 Aug;38(4):302-306
pubmed: 29912802
Sleep Med. 2022 Jan;89:23-30
pubmed: 34875519
J Clin Psychiatry. 2006 May;67(5):756-60
pubmed: 16841625
Aust N Z J Psychiatry. 2019 May;53(5):403-412
pubmed: 30864459
J Trace Elem Med Biol. 2002;16(2):91-7
pubmed: 12195731
J Psychopharmacol. 2020 Jan;34(1):3-78
pubmed: 31829775
Acta Psychiatr Scand. 2018 Aug;138(2):101-109
pubmed: 29786829
Int Clin Psychopharmacol. 1993 Spring;8(1):63-5
pubmed: 8473724
Neuropsychopharmacol Rep. 2021 Jun;41(2):199-206
pubmed: 33704931
Bone Marrow Transplant. 2013 Mar;48(3):452-8
pubmed: 23208313
BJPsych Bull. 2019 Feb;43(1):8-16
pubmed: 30261942
Hum Psychopharmacol. 2020 Jul;35(4):e2739
pubmed: 32420645
BMC Psychiatry. 2015 Aug 12;15:193
pubmed: 26263900
Schizophr Bull. 2021 Oct 21;47(6):1621-1630
pubmed: 34013325
J Clin Pharm Ther. 2021 Oct;46(5):1312-1318
pubmed: 33959995
Am J Psychiatry. 2020 Sep 1;177(9):868-872
pubmed: 32867516
Psychiatry Clin Neurosci. 2018 Aug;72(8):572-579
pubmed: 29761577
BJPsych Open. 2020 Sep 17;6(5):e107
pubmed: 32938513
Am J Psychiatry. 1995 Apr;152(4):648-9
pubmed: 7694925
CNS Drugs. 2016 Feb;30(2):149-61
pubmed: 26884144
JAMA Psychiatry. 2019 May 1;76(5):499-507
pubmed: 30785608
Asian J Psychiatr. 2021 Sep;63:102744
pubmed: 34325252
Psychiatr Serv. 2018 Feb 1;69(2):224-227
pubmed: 29032704
Prog Neuropsychopharmacol Biol Psychiatry. 2008 Dec 12;32(8):2006-7
pubmed: 18824055
Psychiatry Clin Neurosci. 2020 Dec;74(12):667-669
pubmed: 32881226
Lancet. 2019 Sep 14;394(10202):939-951
pubmed: 31303314
Int J Neuropsychopharmacol. 2021 Dec 8;24(12):956-964
pubmed: 34245271
Neuropsychopharmacol Rep. 2020 Sep;40(3):281-286
pubmed: 32602667
Can J Psychiatry. 2017 Sep;62(9):604-616
pubmed: 28703015
Neuropsychopharmacol Rep. 2020 Sep;40(3):208-210
pubmed: 32672006
Psychiatry Clin Neurosci. 2015 Aug;69(8):440-7
pubmed: 25601291
Int J Neuropsychopharmacol. 2019 Sep 1;22(9):560-573
pubmed: 31263888
Acta Psychiatr Scand. 2017 Jul;136(1):37-51
pubmed: 28502099