Bonaccorso Stefania, Ricciardi Angelo, Ouabbou Sophie, Theleritis Christos, Ross-Michaelides Arabella, Metastasio Antonio, Stewart Neil, Mohammed Marwa, Schifano Fabrizio
Highgate Mental Health Centre, Camden & Islington NHS Foundation Trust, Dartmouth Park Hill, N19 5 NX, UK.
University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK.
Brain Behav Immun Health. 2021 May;13:100212. doi: 10.1016/j.bbih.2021.100212. Epub 2021 Jan 28.
Clozapine is among the most effective antipsychotics used for treatment resistant schizophrenia. Adverse reactions to clozapine include neutropenia. In March 2020, at the start of the Coronavirus -19 pandemic, clinicians raised concerns regarding continuation of antipsychotic treatment, and specifically of clozapine, in patients with coronavirus disease. We aimed here at providing a short report focusing on the association between neutropenia and clozapine in a case series of psychiatric inpatients diagnosed with COVID-19.
PATIENTS & METHODS: We retrospectively inspected data of 10 patients on clozapine, admitted to Highgate Mental Health Centre, Camden & Islington NHS Foundation Trust, between March and July 2020; selection was based on their COVID-19 positive PCR test. We used a linear regression model to estimate whether there was a significant drop in the neutrophil count during SARS-CoV-2 infection.The analysis was done in R using a linear regression to the origin.
Data were collected on 10 patients, of which 7 were males. During COVID-19 infection, neutrophils' count (ANC) was 4.13 × 10/l (SD = 2.70) which constituted a significant drop from a baseline value of 5.2 × 10/l (SD = 2.24). The mean relative reduction in ANC was -0.2729 (SD = 0.1666). The beta value of 0.8377 obtained with the linear regression showed that ANC values during SARS-CoV-2 infection were 83.77% of the baseline ANC showing that within the two time points there was a decrease of 16.23%. The linear regression had a pvalue = 8.96 × 10 and an adjusted R of 95.94% which shows that the variability of the data is very well explained by the model. We also compared baseline ANC with ANC values approximately a month after resolution of the infection and results indicate that ANC values return to a 95% of baseline.
Clinicians should bear in mind that a significant drop in neutrophils' count may occur in patients taking clozapine and affected from a SARS-CoV-2 infectionand that this drop is only transitory.
氯氮平是用于治疗难治性精神分裂症最有效的抗精神病药物之一。氯氮平的不良反应包括中性粒细胞减少。2020年3月，在冠状病毒病-19大流行开始时，临床医生对冠状病毒病患者继续使用抗精神病药物，特别是氯氮平表示担忧。我们在此旨在提供一份简短报告，重点关注一系列被诊断为COVID-19的精神科住院患者中性粒细胞减少与氯氮平之间的关联。
我们回顾性检查了2020年3月至7月期间入住卡姆登和伊斯灵顿国民保健服务基金会信托基金旗下海格特心理健康中心的10名服用氯氮平患者的数据；选择依据是他们的COVID-19核酸检测呈阳性。我们使用线性回归模型来估计在严重急性呼吸综合征冠状病毒2感染期间中性粒细胞计数是否有显著下降。分析在R软件中使用原点线性回归进行。
收集了10名患者的数据，其中7名男性。在COVID-19感染期间，中性粒细胞计数（ANC）为4.13×10⁹/L（标准差=2.70），与基线值5.2×10⁹/L（标准差=2.24）相比有显著下降。ANC的平均相对下降为-0.2729（标准差=0.1666）。线性回归得到的β值为0.8377，表明严重急性呼吸综合征冠状病毒2感染期间的ANC值是基线ANC的83.77%，表明在这两个时间点之间下降了16.23%。线性回归的p值=8.96×10⁻⁵，调整后的R²为95.94%，这表明该模型很好地解释了数据的变异性。我们还将基线ANC与感染消退后约一个月的ANC值进行了比较，结果表明ANC值恢复到基线的95%。
临床医生应牢记，服用氯氮平且感染严重急性呼吸综合征冠状病毒2的患者可能会出现中性粒细胞计数显著下降，且这种下降只是暂时的。
