Yi Wenying, She Shenglin, Zhang Jie, Wu Haibo, Zheng Yingjun, Ning Yuping
The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.
Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China.
Neuropsychiatr Dis Treat. 2020 Nov 24;16:2827-2836. doi: 10.2147/NDT.S261503. eCollection 2020.
Previous studies suggest that clozapine is commonly underutilized and that its initiation is delayed in patients with first-episode schizophrenia. Knowledge regarding clozapine use among Chinese patients with early-stage schizophrenia is limited. The aim of the present study was to investigate the point prevalence of and patterns and factors associated with clozapine use in patients with early-stage schizophrenia discharged from a psychiatric hospital in China.
A retrospective study was conducted to analyze the prescriptions of 867 consecutive patients with early-stage schizophrenia who were admitted to the Affiliated Brain Hospital of Guangzhou Medical University between Jan 1, 2011 and Dec 31, 2016.
At discharge from the hospital, 114 (13.1%) patients were prescribed clozapine. Among the patients taking clozapine, 93 patients (81.6%) were prescribed clozapine polypharmacy, and only 21 patients (18.4%) were prescribed clozapine monotherapy. None of the patients were prescribed an overdose of clozapine. The mean daily dosage of clozapine was 160.97 mg, 149.05 mg and 213.69 mg among all patients taking clozapine, patients taking clozapine polypharmacy and patients taking clozapine monotherapy, respectively. The antipsychotic most frequently combined with clozapine was risperidone. Logistic regression suggested that the length of hospital stay, high school education, lower benzodiazepine use and antipsychotic polypharmacy were independently and significantly associated with clozapine use (P<0.05).
Although clozapine has been commonly used in China in recent years, the present study found that clozapine was not commonly used in patients with early-stage schizophrenia. An underutilization and delayed initiation of clozapine may exist in a portion of patients with early-stage schizophrenia. Given the unfavorable outcomes of underutilized and delayed clozapine use, future studies may be needed to assess and increase clozapine use in this population.
既往研究表明，氯氮平在临床上普遍未得到充分利用，首发精神分裂症患者开始使用氯氮平的时间延迟。关于中国早期精神分裂症患者使用氯氮平的相关知识有限。本研究旨在调查中国一家精神病医院出院的早期精神分裂症患者中氯氮平的时点患病率、使用模式及相关因素。
进行一项回顾性研究，分析2011年1月1日至2016年12月31日期间连续收治于广州医科大学附属脑科医院的867例早期精神分裂症患者的处方。
出院时，114例（13.1%）患者使用氯氮平。在使用氯氮平的患者中，93例（81.6%）使用氯氮平联合用药，仅21例（18.4%）使用氯氮平单一疗法。无患者氯氮平过量用药。所有使用氯氮平的患者、使用氯氮平联合用药的患者及使用氯氮平单一疗法的患者中，氯氮平的日均剂量分别为160.97mg、149.05mg和213.69mg。与氯氮平联合使用最频繁的抗精神病药物是利培酮。逻辑回归分析表明，住院时间、高中文化程度、较低的苯二氮䓬类药物使用及抗精神病药物联合用药与氯氮平使用独立且显著相关（P<0.05）。
尽管近年来氯氮平在中国已普遍使用，但本研究发现氯氮平在早期精神分裂症患者中并未得到普遍使用。部分早期精神分裂症患者可能存在氯氮平利用不足及开始使用延迟的情况。鉴于氯氮平利用不足及使用延迟的不良后果，未来可能需要开展研究以评估并增加该人群中氯氮平的使用。
