Parc Sanitari Sant Joan de Déu, Centro de Investigación Biomedica en Red de Salud Mental (CIBERSAM), Sant Boi de Llobregat, Barcelona, Spain.
Bipolar Disorders Unit, Hospital Clinic Barcelona, Institute of Biomedical Research Agusti Pi i Sunyer (IDIBAPS), Centro de Investigación Biomedica en Red de Salud Mental (CIBERSAM), University of Barcelona, Barcelona, Spain.
Eur Neuropsychopharmacol. 2018 Feb;28(2):227-242. doi: 10.1016/j.euroneuro.2017.12.006. Epub 2017 Dec 19.
Lifetime prevalence of substance use disorders (SUD) in patients with schizophrenia is nearly 50%. Nicotine, alcohol, and cannabis are the substances most frequently used, with a high percentage of poly-substance users. There are few available data about pharmacological approaches in this population. Amongst antipsychotics, clozapine shows positive evidence in the literature. The aim of the present article is to provide systematic review on the efficacy of clozapine in SUD improvement in schizophrenic patients. PRISMA recommendations were followed (PROSPERO id: CRD42017059299). Five studies for nicotine use and nine studies for SUD (other than nicotine) were analyzed. Regarding nicotine use, results from randomized controlled trials (RCT) have found a decrease in nicotine use after 12 weeks of 200-600mg/day clozapine, as compared with lower doses. In SUD improvement (other than nicotine), RCT have shown superiority of clozapine when compared with risperidone, in short-term studies (from 4 to 12 weeks) performed in cannabis users. In long-term studies (1 year), clozapine was equal to ziprasidone in reducing cannabis use and equal to treatment as usual in reducing alcohol use. We conclude that positive results on nicotine use are scarce and derived from studies with a low degree of evidence. Evidence of clozapine on SUD (other than nicotine) is stronger, especially when clozapine is compared with first generation antipsychotics in poly-substance users. When compared with second generation antipsychotics, clozapine was superior to risperidone but equal to olanzapine or ziprasidone in poly-substance and cannabis users.
精神分裂症患者物质使用障碍（SUD）的终身患病率接近 50%。尼古丁、酒精和大麻是最常使用的物质，且大多数为多物质使用者。关于该人群的药物治疗方法，目前数据较少。在抗精神病药物中，氯氮平在文献中显示出积极的证据。本文旨在提供氯氮平改善精神分裂症患者 SUD 的疗效的系统评价。遵循 PRISMA 建议（PROSPERO id：CRD42017059299）。分析了 5 项尼古丁使用研究和 9 项 SUD（除尼古丁外）研究。关于尼古丁使用，随机对照试验（RCT）的结果发现，与较低剂量相比，每天 200-600mg 氯氮平治疗 12 周后，尼古丁使用减少。在 SUD 改善（除尼古丁外）方面，RCT 表明，在短期研究（4-12 周）中，氯氮平在治疗大麻使用者时优于利培酮。在长期研究（1 年）中，氯氮平在减少大麻使用方面与齐拉西酮相当，在减少酒精使用方面与常规治疗相当。我们得出结论，关于尼古丁使用的阳性结果很少，且来自于低证据等级的研究。氯氮平在 SUD（除尼古丁外）方面的证据更强，特别是当氯氮平与第一代抗精神病药在多物质使用者中比较时。与第二代抗精神病药相比，氯氮平在多物质和大麻使用者中优于利培酮，但与奥氮平或齐拉西酮相当。
