TY - JOUR
T1 - The impact of delay in clozapine initiation on treatment outcomes in patients with treatment-resistant schizophrenia
T2 - A systematic review
AU - Shah, Parita
AU - Iwata, Yusuke
AU - Plitman, Eric
AU - Brown, Eric E.
AU - Caravaggio, Fernando
AU - Kim, Julia
AU - Nakajima, Shinichiro
AU - Hahn, Margaret
AU - Remington, Gary
AU - Gerretsen, Philip
AU - Graff-Guerrero, Ariel
N1 - Funding Information:
This work was supported by the Canadian Institutes of Health Research (MOP- 142493 and 141968 ) (PI AG-G).
Funding Information:
P.S. reports no conflict of interest. Y.I. has received fellowship grants from Canadian Institute of Health Research (CIHR), Keio University Medical Science Foundation, Mitsukoshi Foundation, and manuscript fees from Dainippon Sumitomo Pharma. E.P. reports receiving funding from the Vanier Canada Graduate Scholarship, the Ontario Graduate Scholarship, and the Canada Graduate Scholarship – Master's. E.B. reports no conflict of interest. F.C. reports no conflict of interest. J.K. reports receiving Ontario Graduate Scholarship (OGS). S.N. has received fellowship grants from Canadian Institute of Health Research (CIHR), research support from Japan Society for the Promotion of Science, Japan Agency for Medical Research and Development, Japan Research Foundation for Clinical Pharmacology, Naito Foundation, Takeda Science Foundation, Uehara Memorial Foundation, Daiichi Sankyo, and manuscript fees or speaker's honoraria from Dainippon Sumitomo Pharma and Yoshitomi Yakuhin within the past three years. M.H. reports being on an advisory board for Alkermes in the past. G.R. reports external funding from CIHR, travel support from Neurocrine Biosciences, and research support from HLS. P.G. reports receiving research support from CIHR, Ontario Mental Health Foundation, and the Centre for Addiction and Mental Health. A.G. has received support from the United States National Institute of Health, CIHR, OMHF, Consejo Nacional de Ciencia y Tecnología, the Instituto de Ciencia y Tecnología del DF, the Brain & Behavior Research Foundation (Formerly NARSAD), the Ontario Ministry of Health and Long-Term Care, the Ontario Ministry of Research and Innovation Early Research Award, and Janssen.
Publisher Copyright:
© 2018 Elsevier B.V.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2018/10
Y1 - 2018/10
N2 - Approximately one-third of patients with schizophrenia have treatment-resistant schizophrenia (TR-SCZ), which is a condition characterized by suboptimal response to antipsychotics other than clozapine. Importantly, treatment with clozapine—the only antipsychotic with an indication for TR-SCZ—is often delayed, which could contribute to negative outcomes. Given that the specific impact of delay in clozapine initiation is not well understood, we aimed to conduct a systematic search of the Ovid Medline ® database to identify English language publications exploring the impact of delay in clozapine initiation on treatment outcomes in patients with TR-SCZ. Additionally, clinico-demographic factors associated with clozapine delay were examined. Our search identified four retrospective studies that showed an association between longer delay in clozapine initiation and poorer treatment outcomes, even after including covariates, such as age, sex, and duration of illness. In addition, we found six studies that showed an association between age and clozapine delay, but results with regard to other clinico-demographic variables were inconsistent. Overall, the available literature reveals a possible link between delay in clozapine use and poorer treatment outcomes in patients with TR-SCZ. However, given the relatively small number of studies on this clinically important topic, future research is warranted to draw more definitive conclusions.
AB - Approximately one-third of patients with schizophrenia have treatment-resistant schizophrenia (TR-SCZ), which is a condition characterized by suboptimal response to antipsychotics other than clozapine. Importantly, treatment with clozapine—the only antipsychotic with an indication for TR-SCZ—is often delayed, which could contribute to negative outcomes. Given that the specific impact of delay in clozapine initiation is not well understood, we aimed to conduct a systematic search of the Ovid Medline ® database to identify English language publications exploring the impact of delay in clozapine initiation on treatment outcomes in patients with TR-SCZ. Additionally, clinico-demographic factors associated with clozapine delay were examined. Our search identified four retrospective studies that showed an association between longer delay in clozapine initiation and poorer treatment outcomes, even after including covariates, such as age, sex, and duration of illness. In addition, we found six studies that showed an association between age and clozapine delay, but results with regard to other clinico-demographic variables were inconsistent. Overall, the available literature reveals a possible link between delay in clozapine use and poorer treatment outcomes in patients with TR-SCZ. However, given the relatively small number of studies on this clinically important topic, future research is warranted to draw more definitive conclusions.
KW - Clozapine
KW - Delay
KW - Outcome
KW - Psychosis
KW - Response
KW - Schizophrenia
KW - Treatment-resistant
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U2 - 10.1016/j.psychres.2018.06.070
DO - 10.1016/j.psychres.2018.06.070
M3 - Review article
C2 - 30015109
AN - SCOPUS:85049774360
SN - 0165-1781
VL - 268
SP - 114
EP - 122
JO - Psychiatry Research
JF - Psychiatry Research
ER -
