Gee Siobhan H, Shergill Sukhwinder S, Taylor David M
Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
J Psychopharmacol. 2016 Aug;30(8):819-25. doi: 10.1177/0269881116642745. Epub 2016 Apr 19.
The objective of this study was to examine whether delays in clozapine treatment affect outcomes once clozapine is started and identify factors that affect these outcomes.
Patients starting clozapine in a four year period at South London and the Maudsley NHS Foundation Trust were included. Clinical details were gathered from clinical notes. Primary outcome was net change in inpatient admissions comparing the periods before and after clozapine was started.
There was no significant association between the length of clozapine delay (mean clozapine delay = 3.93 years) and number or length of inpatient admissions once clozapine had been started (mean net change in days of admission = 16.74 days), F value = 0.901, p = 0.345. Clozapine reduced the total number of bed days per year, but only if treatment was continued - stopping resulted in inpatient admissions returning to pre-clozapine levels. Younger patients had a greater reduction in bed days when taking clozapine (p = 0.027).
Clozapine reduces the number of inpatient days, regardless of the chronicity of the illness at the time clozapine was started. Continued compliance with clozapine is necessary to maintain this benefit. Reduction in bed days is greater in younger patients, suggesting early initiation of clozapine may be beneficial.
本研究的目的是探讨氯氮平治疗延迟是否会影响开始使用氯氮平后的治疗结果，并确定影响这些结果的因素。
纳入在四年期间于南伦敦和莫兹利国民保健服务基金会信托机构开始使用氯氮平的患者。从临床记录中收集临床细节。主要结局是比较开始使用氯氮平前后住院天数的净变化。
氯氮平延迟时间（平均氯氮平延迟时间 = 3.93年）与开始使用氯氮平后的住院次数或住院时间之间无显著关联（住院天数的平均净变化 = 16.74天），F值 = 0.901，p = 0.345。氯氮平减少了每年的总住院天数，但前提是持续治疗——停药会导致住院次数恢复到使用氯氮平前的水平。年轻患者服用氯氮平时住院天数减少得更多（p = 0.027）。
无论开始使用氯氮平时疾病的慢性程度如何，氯氮平均可减少住院天数。持续遵医嘱服用氯氮平对于维持这一益处是必要的。年轻患者住院天数减少得更多，这表明早期开始使用氯氮平可能有益。
