Reasons for discontinuing clozapine: a cohort study of patients commencing treatment

Legge, Sophie, Hamshere, Marian L. ORCID: https://orcid.org/0000-0002-8990-0958, Hayes, Richard D., Downs, Johnny, O'Donovan, Michael Conlon ORCID: https://orcid.org/0000-0001-7073-2379, Owen, Michael John ORCID: https://orcid.org/0000-0003-4798-0862, Walters, James Tynan Rhys ORCID: https://orcid.org/0000-0002-6980-4053 and McCabe, James H. 2016. Reasons for discontinuing clozapine: a cohort study of patients commencing treatment. Schizophrenia Research 174 , pp. 113-119. 10.1016/j.schres.2016.05.002

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Abstract

Background Clozapine is uniquely effective in the management of treatment-resistant schizophrenia (TRS). However, a substantial proportion of patients discontinue treatment and this carries a poor prognosis. Methods We investigated the risk factors, reasons and timing of clozapine discontinuation in a two-year retrospective cohort study of 316 patients with TRS receiving their first course of clozapine. Reasons for discontinuation of clozapine and duration of treatment were obtained from case notes and Cox regression was employed to test the association of baseline clinical factors with clozapine discontinuation. Results A total of 142 (45%) patients discontinued clozapine within two years. By studying the reasons for discontinuations due to a patient decision, we found that adverse drug reactions (ADRs) accounted for over half of clozapine discontinuations. Sedation was the most common ADR cited as a reason for discontinuation and the risk of discontinuation due to ADRs was highest in the first few months of clozapine treatment. High levels of deprivation in the neighbourhood where the patient lived were associated with increased risk of clozapine discontinuation (HR = 2.12, 95% CI 1.30–3.47). Conclusions Living in a deprived neighbourhood was strongly associated with clozapine discontinuation. Clinical management to reduce the burden of ADRs in the first few months of treatment may have a significant impact and help more patients experience the benefits of clozapine treatment.

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Medicine MRC Centre for Neuropsychiatric Genetics and Genomics (CNGG) Neuroscience and Mental Health Research Institute (NMHRI)
Subjects:	R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Publisher:	Elsevier
ISSN:	0920-9964
Date of First Compliant Deposit:	11 May 2016
Date of Acceptance:	11 May 2016
Last Modified:	07 May 2023 06:09
URI:	https://orca.cardiff.ac.uk/id/eprint/90793

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