Kuzo, Nazar and Haen, Ekkehard and Ho, Dominic M. and Takeuchi, Hiroyoshi and Piras, Marianna and Eap, Chin-Bin and de Filippis, Renato and Homan, Philipp and Kane, John M. and Roy, Marc-Andre and Paulzen, Michael and Schoretsanitis, Georgios (2023) Clozapine once- versus multiple-daily dosing: a two-center cross-sectional study, systematic review and meta-analysis. EUROPEAN ARCHIVES OF PSYCHIATRY AND CLINICAL NEUROSCIENCE, 273. pp. 1567-1578. ISSN 0940-1334, 1433-8491
Full text not available from this repository. (Request a copy)Abstract
Evidence regarding effectiveness and safety of clozapine once- vs. multiple-daily dosing is limited. We compared demographic and clinical parameters between patients with once- vs. multiple-daily dosing in the Department of Psychiatry and Psychotherapy, University of Regensburg, Germany (AGATE dataset), and the Department of Psychiatry, Lausanne University Hospital, Switzerland, using non-parametric tests. Effectiveness and safety outcomes were available in the AGATE dataset. We performed a systematic review in PubMed/Embase until February 2022, meta-analyzing studies comparing clozapine once- vs. multiple-daily-dosing. We estimated a pooled odds ratio for adverse drug-induced reactions (ADRs) and meta-analyzed differences regarding clinical symptom severity, age, percentage males, smokers, clozapine dose, and co-medications between patients receiving once- vs. multiple-daily dosing. Study quality was assessed using the Newcastle-Ottawa-Scale. Of 1494 and 174 patients included in AGATE and Lausanne datasets, clozapine was prescribed multiple-daily in 74.8% and 67.8%, respectively. In the AGATE cohort, no differences were reported for the clinical symptoms severity or ADR rate (p > 0.05). Meta-analyzing eight cohorts with a total of 2810 clozapine-treated individuals, we found more severe clinical symptoms (p = 0.036), increased ADR risk (p = 0.01), higher clozapine doses (p < 0.001), more frequent co-medication with other antipsychotics (p < 0.001), benzodiazepines (p < 0.001), anticholinergics (p = 0.039), and laxatives (p < 0.001) in patients on multiple- vs. once-daily dosing. Of six studies, five were rated as good, and one as poor quality. Patients responding less well to clozapine may be prescribed higher doses multiple-daily, also treated with polypharmacy, potentially underlying worse safety outcomes. Patient preferences and adherence should be considered during regimen selection.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | PSYCHOTROPIC-DRUGS; CLINICAL-PRACTICE; RISPERIDONE; Treatment-resistant schizophrenia; Clozapine; Divided dosing; Antipsychotics; Polypharmacy |
| Subjects: | 600 Technology > 610 Medical sciences Medicine 600 Technology > 615 Pharmacy |
| Divisions: | Medicine > Lehrstuhl für Psychiatrie und Psychotherapie |
| Depositing User: | Petra Gürster |
| Date Deposited: | 07 Sep 2023 12:25 |
| Last Modified: | 07 Sep 2023 12:25 |
| URI: | https://pred.uni-regensburg.de/id/eprint/58635 |
Actions (login required)
 |
View Item |
