Augmenting Clozapine Response in Treatment-Resistant Schizophrenia

2010 ◽  
pp. 129-151 ◽  
Author(s):  
Gary Remington
Keyword(s):  
Treatment Resistant ◽  
Clozapine Response

Clozapine response trajectories and predictors of non-response in treatment-resistant schizophrenia: a chart review study

2019 ◽  
Vol 270 (1) ◽  
pp. 11-22 ◽  
Author(s):  
Parita Shah ◽  
Yusuke Iwata ◽  
Eric E. Brown ◽  
Julia Kim ◽  
Marcos Sanches ◽  
...  
Keyword(s):  
Chart Review ◽  
Treatment Resistant ◽  
Clozapine Response ◽  
Review Study

Clozapine response in treatment resistant schizophrenics with substance abuse

1995 ◽  
Vol 15 (1-2) ◽  
pp. 150-151 ◽  
Author(s):  
Elizabeth Gale ◽  
Karen Hirsch ◽  
Dawn Kent ◽  
Robert Conley
Keyword(s):  
Substance Abuse ◽  
Treatment Resistant ◽  
Clozapine Response

Schizophrenic syndromes and clozapine response in treatment-resistant schizophrenia

1998 ◽  
Vol 77 (1) ◽  
pp. 21-28 ◽  
Author(s):  
Vicente Molina Rodriguez ◽  
M.Luisa Catalina ◽  
J.Antonio García-Noblejas ◽  
Pedro Cuesta
Keyword(s):  
Treatment Resistant ◽  
Clozapine Response

scholarly journals SU118. Cognitive Impairment and Clozapine Response in Treatment-Resistant Schizophrenia—A Cross-Sectional Study

2017 ◽  
Vol 43 (suppl_1) ◽  
pp. S204-S204
Author(s):  
Shinichiro Nakajima ◽  
Yusuke Iwata ◽  
Eric Plitman ◽  
Jun Ku Chung ◽  
Philip Gerretsen ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Treatment Resistant ◽  
Cross Sectional ◽  
Clozapine Response

scholarly journals Demographic and clinical variables associated with response to clozapine in schizophrenia: a systematic review and meta-analysis

2021 ◽  
Vol 51 (3) ◽  
pp. 376-386
Author(s):  
Kira Griffiths ◽  
Edward Millgate ◽  
Alice Egerton ◽  
James H. MacCabe
Keyword(s):  
Meta Analysis ◽  
Schizophrenia Spectrum Disorders ◽  
Treatment Resistant ◽  
Illness Onset ◽  
Clozapine Treatment ◽  
Duration Of Illness ◽  
Schizophrenia Spectrum ◽  
Younger Age ◽  
Clozapine Response ◽  
Spectrum Disorders

AbstractClozapine is the only licensed pharmacotherapy for treatment-resistant schizophrenia. However, response to clozapine is variable. Understanding the demographic and clinical features associated with response to clozapine may be useful for patient stratification for clinical trials or for identifying patients for earlier initiation of clozapine. We systematically reviewed the literature to investigate clinical and demographic factors associated with variation in clozapine response in treatment-resistant patients with schizophrenia spectrum disorders. Subsequently, we performed a random-effects meta-analysis to evaluate differences in duration of illness, age at clozapine initiation, age of illness onset, body weight and years of education between clozapine responders and non-responders. Thirty-one articles were eligible for qualitative review and 17 of these were quantitatively reviewed. Shorter duration of illness, later illness onset, younger age at clozapine initiation, fewer hospitalisations and fewer antipsychotic trials prior to clozapine initiation showed a trend to be significantly associated with a better response to clozapine. Meta-analysis of seven studies, totalling 313 subjects, found that clozapine responders had a significantly shorter duration of illness compared to clozapine non-responders [g = 0.31; 95% confidence interval (CI) 0.06–0.56; p = 0.01]. The results imply that a delay in clozapine treatment may result in a poorer response and that a focus on prompt treatment with clozapine is warranted.

scholarly journals CLOZAPINE RESPONSE IN TREATMENT RESISTANT SCHIZOPHRENIA: PREDICTORS OF OVERALL FUNCTIONING

2019 ◽  
Author(s):  
Amina Aissa ◽  
Feriel Ellouze ◽  
Sana Seghaier ◽  
H BEN AMMAR ◽  
EMIRA KHELIFA ◽  
...  
Keyword(s):  
Treatment Resistant ◽  
Clozapine Response ◽  
Overall Functioning

scholarly journals M212. A SYSTEMATIC REVIEW AND META-ANALYSIS OF CLINICAL VARIABLES ASSOCIATED WITH RESPONSE TO CLOZAPINE IN TREATMENT RESISTANT SCHIZOPHRENIA

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S217-S217
Author(s):  
Kira Griffiths ◽  
James MacCabe ◽  
Alice Egerton
Keyword(s):  
Systematic Review ◽  
Age Of Onset ◽  
Meta Analysis ◽  
Treatment Resistance ◽  
Schizophrenia Spectrum Disorders ◽  
Treatment Resistant ◽  
Clinical Variables ◽  
Duration Of Illness ◽  
Patient Groups ◽  
Clozapine Response

Abstract Background Approximately one third of patients with schizophrenia display suboptimal response to two trials of non-clozapine antipsychotic medication and may be termed treatment resistant. Clozapine is the only licensed pharmacotherapy for treatment resistant schizophrenia, but response to clozapine is variable and can only be determined through a trial of treatment. Understanding demographic and clinical sources of varied response to clozapine may be useful in the optimisation of clinical treatment algorithms and stratification of patient groups for clinical trials of early use of clozapine. Methods We systematically reviewed literature to investigate clinical and demographic factors associated with variation in clozapine response. Articles were eligible for review if they reported differences in clozapine response as a function of baseline variables within patient samples of schizophrenia spectrum disorders. In a second step, a random-effects meta-analysis to study group mean differences in age, age of onset and duration of illness between clozapine responders and non-responders was performed. Results Thirty-one articles were eligible for qualitative review. The systematic review found that a poorer response to clozapine was associated with older age at clozapine initiation, younger age at illness onset and longer delay in clozapine initiation. A higher number of previous hospitalisations and antipsychotic trials prior to treatment with clozapine were also associated with poorer outcomes. Both systematic review and meta-analysis identified that longer durations of illness before clozapine initiation were associated with worse clinical outcomes. In a total sample of 313 participants (n = 158 responders), clozapine responders had a significantly shorter duration of illness than non-responders (g = - 0.31; 95% CI, 0.06 - 0.56; p = 0.02). Analysis was then limited to studies with a minimum follow-up period of 12 weeks to align with the recommended amount of time to monitor clozapine response. The difference in duration of illness between responder versus non-responder groups remained significant and overall effect size increased (g = - 0.42; 95% CI, 0.17 – 0.67; p < 0.001). Between study heterogeneity was low (Q = 3.59, I2 = 0%, P = 0.61). Discussion The results imply that delay in clozapine treatment is associated with worse response and support the view that initiation of clozapine earlier in illness may be beneficial. Although we cannot make causal assertions from the data presented, poor response to clozapine when prescribed after a longer delay is likely due to a combination of factors; including the effects of sustained active symptoms on neurobiological integrity, social functioning and self-care. Given evidence that early non-response to conventional antipsychotics predicts a later diagnosis of treatment resistance and poorer outcomes, identifying treatment resistance and prescribing clozapine earlier in the illness course would prevent unnecessary loss of time in the treatment of refractory psychosis. Current research into clinical variables associated with clozapine response is limited to few studies but future investigation into the predictive value of these variables is warranted. This is important given the relative ease and low-cost clinical information can be obtained from acutely unwell patient groups who may poorly tolerate more invasive research and clinical procedures.

Clozapine response in early treatment-resistant schizophrenia

1997 ◽  
Vol 1 (4) ◽  
pp. 261-268 ◽  
Author(s):  
Grigori Joffe ◽  
Juri Rybak ◽  
Mark Burkin ◽  
Dmitri Burkin ◽  
Björn Appelberg ◽  
...  
Keyword(s):  
Early Treatment ◽  
Treatment Resistant ◽  
Clozapine Response

scholarly journals Clozapine Response Rates among People with Treatment-Resistant Schizophrenia: Data from a Systematic Review and Meta-Analysis

2017 ◽  
Vol 62 (11) ◽  
pp. 772-777 ◽  
Author(s):  
Dan Siskind ◽  
Victor Siskind ◽  
Steve Kisely
Keyword(s):  
Systematic Review ◽  
Confidence Interval ◽  
Response Rate ◽  
Meta Analysis ◽  
Percentage Change ◽  
Treatment Resistant ◽  
Syndrome Scale ◽  
Clozapine Response ◽  
Using Data ◽  
Negative Syndrome

Clozapine is the most effective antipsychotic for the 25% to 33% of people with schizophrenia who are treatment resistant, but not all people achieve response. Using data from a previously published clozapine systematic review and meta-analysis, we explored the proportion of people who achieved response and examined the absolute and percentage change in Positive and Negative Syndrome Scale (PANSS) scores. Overall, 40.1% (95% confidence interval [CI], 36.8%-43.4%) responded, with a mean reduction in PANSS of 22.0 points (95% CI, 20.9-23.1), a reduction of 25.8% (95% CI, 24.7%-26.9%) from baseline. These reductions are clinically meaningful. A 40% response rate to clozapine suggests that 12% to 20% of people with schizophrenia will be ultra-resistant.

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