在先前治疗期间出现白细胞减少或中性粒细胞减少后再次使用氯氮平。
Rechallenge with clozapine following leucopenia or neutropenia during previous therapy.
作者信息
Dunk Louisa R, Annan Linda J, Andrews Christopher D
机构信息
Histopathology Department, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK.
出版信息
Br J Psychiatry. 2006 Mar;188:255-63. doi: 10.1192/bjp.188.3.255.
BACKGROUND
Further treatment with clozapine is contraindicated in any patient who has previously experienced leucopenia or neutropenia during clozapine therapy.
AIMS
To investigate the results of such a rechallenge in 53 patients.
METHOD
An analysis was made of the demographic, haematological and outcome data of patients in the UK and Ireland who were rechallenged with clozapine following leucopenia or neutropenia during previous clozapine therapy.
RESULTS
Of 53 patients who were rechallenged, 20 (38%) experienced a further blood dyscrasia. In 17 of these 20 patients (85%) the second blood dyscrasia was more severe (P<0.001), in 12 (60%) it lasted longer (P=0.0368) and in 17 (85%) it occurred more quickly on rechallenge (P<0.001). Of the original 53 patients, 55% (29 patients) are still receiving clozapine.
CONCLUSIONS
No clear risk factor for repeat blood dyscrasias was identified. Despite this, after risks and benefits have been considered, rechallenge may well be justified in some patients.
背景
曾在氯氮平治疗期间出现白细胞减少或中性粒细胞减少的患者，禁忌再次使用氯氮平进行进一步治疗。
目的
调查53例患者再次使用氯氮平治疗的结果。
方法
对英国和爱尔兰曾在氯氮平治疗期间出现白细胞减少或中性粒细胞减少后再次使用氯氮平治疗的患者的人口统计学、血液学及治疗结果数据进行分析。
结果
在53例再次使用氯氮平治疗的患者中，20例（38%）出现了再次血液系统异常。在这20例患者中的17例（85%），第二次血液系统异常更为严重（P<0.001）；12例（60%）持续时间更长（P=0.0368）；17例（85%）在再次用药时发作更快（P<0.001）。在最初的53例患者中，55%（29例）仍在接受氯氮平治疗。
结论
未发现再次出现血液系统异常的明确危险因素。尽管如此，在权衡风险和益处后，部分患者再次使用氯氮平治疗可能是合理的。
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