Kitchen David, Till Alex, Xavier Panchu
Mersey Care NHS Foundation Trust, Liverpool, UK.
Mersey Internal Audit Agency, Liverpool, UK.
BJPsych Bull. 2022 Oct;46(5):267-270. doi: 10.1192/bjb.2021.36.
Routine therapeutic drug monitoring in clozapine therapy has previously not been considered justifiable. Using observational data, the clinical utility of annual clozapine assay monitoring is explored within a large mental health trust.
After the introduction of routine monitoring, the rate of clozapine assays rose to 2.3 per patient per year, with a consistent reduction in high-risk clozapine assays (<0.1 mg/L or >1.0 mg/L or any result more than 24 months old). High-risk assays are associated with a mortality rate of 31.6 deaths per 1000 patients, more than twice that of those within the target range (0.35-0.60 mg/L and conducted within the past 12 months) ( = 0.048).
Routine clozapine assay monitoring has significant clinical utility. Our simple but targeted approach can be readily implemented to reduce the number of patients with high-risk clozapine assay levels, potentially reduce all-cause mortality and provide optimal treatment for those with treatment-resistant schizophrenia.
以往认为在氯氮平治疗中进行常规治疗药物监测并无必要。利用观察性数据，在一个大型心理健康信托机构中探讨了每年进行氯氮平分析监测的临床效用。
引入常规监测后，氯氮平分析的比率升至每人每年2.3次，高风险氯氮平分析（<0.1毫克/升或>1.0毫克/升或任何超过24个月的结果）持续减少。高风险分析与每1000名患者31.6例死亡的死亡率相关，是目标范围内（0.35 - 0.60毫克/升且在过去12个月内进行）患者死亡率的两倍多（P = 0.048）。
常规氯氮平分析监测具有显著的临床效用。我们简单但有针对性的方法可轻易实施，以减少氯氮平分析水平处于高风险的患者数量，潜在降低全因死亡率，并为难治性精神分裂症患者提供最佳治疗。
