Kang Byung-Jo, Cho Man-Je, Oh Jung-Tae, Lee Yanghyun, Chae Beang-Jin, Ko Jaewook
Department of Psychiatry, School of Medicine, Kyungpook National University, Taegu, Republic of Korea.
Hum Psychopharmacol. 2006 Aug;21(6):387-91. doi: 10.1002/hup.779.
This study documents the incidences of agranulocytosis and neutropenia, and the patterns of incidence of the side effects of long-term clozapine treatment in order to determine an appropriate time to stop the Clozaril Patient Monitoring System (CPMS).
Hematological, demographic, and other data from the CPMS for 6782 patients who took clozapine for the past 11 years in the Republic of Korea has been analyzed.
Twenty-nine (53.7%) of fifty-four agranulocytosis cases occurred within the first 18 weeks. The cumulative incidence of agranulocytosis was 1.64% between 6 and 11 years and the crude incidence was 0.8%. Neutropenia occurred in 697 patients, and 365 (52.4%) of these cases occurred within the first 18 weeks. The cumulative incidence of neutropenia was 19.8% between 8 and 11 years, and the crude incidence was 10.3%. There were no cases of agranulocytosis or neutropenia after the 9th year of clozapine treatment.
The incidence of agranulocytosis in the Republic of Korea was similar to those in the rest of the world. While agranulocytosis began several years after clozapine treatment, long-term monitoring of white blood cells is necessary. We suggest that the CPMS should be stopped or less frequently after the 9th year of treatment.
本研究记录粒细胞缺乏症和中性粒细胞减少症的发生率，以及长期使用氯氮平治疗的副作用发生模式，以确定停用氯氮平患者监测系统（CPMS）的合适时间。
对韩国过去11年服用氯氮平的6782例患者的血液学、人口统计学和其他CPMS数据进行了分析。
54例粒细胞缺乏症病例中有29例（53.7%）发生在最初18周内。6至11年间粒细胞缺乏症的累积发生率为1.64%，粗发生率为0.8%。697例患者发生中性粒细胞减少症，其中365例（52.4%）发生在最初18周内。8至11年间中性粒细胞减少症的累积发生率为19.8%，粗发生率为10.3%。氯氮平治疗9年后未出现粒细胞缺乏症或中性粒细胞减少症病例。
韩国粒细胞缺乏症的发生率与世界其他地区相似。虽然粒细胞缺乏症在氯氮平治疗数年后开始出现，但仍有必要对白细胞进行长期监测。我们建议在治疗9年后应停用CPMS或减少监测频率。
