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Abstract
Objectives
Approximately 30% of individuals diagnosed with schizophrenia suffer from treatment-resistant schizophrenia. Clozapine is underutilized in the management of treatment-resistant schizophrenia. To understand contributing factors, we analyzed the time course and causes of clozapine discontinuations that occurred over a 20-year period in a clinical setting.
Methods
The reasons for discontinuation and duration of clozapine treatment from a retrospective database of 138 patients with schizophrenia who had prescribed clozapine at least a month were reviewed, with the motives for discontinuation coded. The causes for termination were analyzed.
Results
Over two-thirds of the patient had ceased clozapine. The two most common causes for discontinuation were side-ef-fects (50%), and own decision (30%). Somnolence accounted for 34% of all side-effects induced discontinuations. Hematologi-cal problems accounted for 23% of side-effect. The Maximal treatment dose of clozapine was higher in continuation group (442.36 mg) than in discontinuation group (397.26 mg). The CGI-S score when prescribing clozapine last was higher in discontinuation group than in continuous group. The patients who took atypical antipsychotics before clozapine tended to cease clozapine because of side-effects than who took typical agent.
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Table 1.
Factors for clozapine discontinuation
Table 2.
Sociodemographic and clinical characteristics of the subjects
| Total | Continuation, n (%) | Discontinuation, n (%) | χ2 | p-value | |
|---|---|---|---|---|---|
| Whole Sample | 137 | 41 (30.4) | 96 (69.6) | ||
| Gender | |||||
| Male | 73 | 23 (56.1) | 50 (52.1) | 0.186 | 0.666 |
| Female | 64 | 19 (43.9) | 46 (47.9) | ||
| Education | |||||
| 0-12 | 75 | 24 (64.9) | 51 (60.7) | 0.188 | 0.665 |
| ＞12 | 47 | 13 (35.1) | 33 (39.3) | ||
| Married | |||||
| Single | 102 | 30 (73.2) | 72 (76.6) | 0.528 | 0.768 |
| Married | 25 | 9 (22.0) | 16 (17.0) | ||
| Divorced | 8 | 2 (4.9) | 6 (6.4) | ||
| Living arrangement | |||||
| Living alone | 17 | 3 (7.3) | 14 (15.1) | 1.538 | 0.215 |
| Living with family | 117 | 39 (92.7) | 79 (84.9) | ||
| Job | |||||
| No | 86 | 23 (57.5) | 63 (66.3) | 0.946 | 0.331 |
| Yes∗ | 49 | 17 (42.5) | 32 (33.7) | ||
| Economic status | |||||
| Low | 37 | 10 (25.6) | 27 (30.0) | 0.253 | 0.615 |
| High | 92 | 29 (74.4) | 63 (70.0) | ||
| Concomitant antipsychoti | ics | ||||
| No | 74 | 13 (31.7) | 61 (63.5) | 11.722 | 0.001 |
| Yes | 63 | 28 (68.3) | 35 (36.5) |
Table 3.
Comparison between continuation group and discontinuation group
| Continuation, Mean (SD) | Discontinuation, Mean (SD) | t | p | |
|---|---|---|---|---|
| Age of onset | 21.13 (7.53) | 22.80 (8.04) | -1.124 | 0.263 |
| Age at clozapine start | 29.85 (12.52) | 29.52 (10.74) | 0.158 | 0.875 |
| Duration of untreatment | 10.19 (32.26) | 9.79 (19.48) | 0.082 | 0.935 |
| Hospitalization number before using clozapine | 2.93 (3.28) | 2.13 (2.54) | 1.377 | 0.174 |
| Hospitalization number in the use of clozapine | 0.63 (1.75) | 0.50 (0.88) | 0.553 | 0.581 |
| Body mass index (BMI) | 23.37 (3.01) | 24.15 (4.56) | -1.054 | 0.295 |
| Clozapine maximal dose∗ | 442.36 (90.40) | 397.26 (95.34) | 2.362 | 0.020 |
| Clozapine last prescription dose∗ | 279.29 (137.00) | 260.27 (127.06) | 0.710 | 0.480 |
| Clinical Global Impression-Severity (CGI-S) scale before starting clozapine | 5.71 (1.12) | 5.75 (1.18) | -0.201 | 0.842 |
| Clinical Global Impression-Severity (CGI-S) scale when prescribing clozapine last | 3.12 (0.78) | 3.93 (1.06) | -4.356 | ＜0.001 |
Table 4.
Clinical characteristics of the subjects
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