Department of Pharmacy, Akita University Hospital, Akita, Japan.
Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan.
J Clin Pharm Ther. 2021 Oct;46(5):1312-1318. doi: 10.1111/jcpt.13432. Epub 2021 May 7.
The schizophrenia guidelines in Japan and many other countries describe clozapine as the first-choice drug for patients with treatment-resistant schizophrenia. However, there have been no reports to date on the effects of the introduction of clozapine on the prescription of other antipsychotics and concomitant drugs.
In this study, we retrospectively investigated the prescription of antipsychotics and concomitant drugs before vs 6 months after and 12 months after switching to clozapine.
Clozapine was introduced to 62 patients with treatment-resistant schizophrenia, and 51 patients continued on clozapine therapy. Six months after switching to clozapine, there was a significant decrease in the mean number of antipsychotic drugs (2.04 ± 0.75 vs 1.10 ± 0.30: p < 0.001) and in the mean chlorpromazine equivalent value (1024 ± 73 mg/day vs 781 ± 391 mg/day: p < 0.001) compared to before switching. Moreover, antipsychotic monotherapy increased from 24% to 90% after switching to clozapine. In addition, the number of concomitant benzodiazepines, anti-parkinson drugs and antidepressants also significantly decreased 6 and 12 months after switching to clozapine (p < 0.001 for benzodiazepines and anti-parkinson drugs, and p < 0.05 for antidepressants).
Our study suggests that switching to clozapine may reduce the use of antipsychotic combination therapy, and may also reduce the number of concomitant drugs.
日本和许多其他国家的精神分裂症指南将氯氮平描述为治疗抵抗性精神分裂症患者的首选药物。然而，迄今为止，尚无关于引入氯氮平对其他抗精神病药物和伴随药物处方影响的报道。
在这项研究中，我们回顾性调查了在转换为氯氮平之前、之后 6 个月和 12 个月时抗精神病药物和伴随药物的处方情况。
氯氮平被引入 62 例治疗抵抗性精神分裂症患者，其中 51 例继续接受氯氮平治疗。转换为氯氮平后 6 个月，抗精神病药物的平均数量（2.04±0.75 与 1.10±0.30：p<0.001）和氯丙嗪等效值（1024±73mg/天与 781±391mg/天：p<0.001）显著下降与转换前相比。此外，转换为氯氮平后，抗精神病药单药治疗的比例从 24%增加到 90%。此外，转换为氯氮平后 6 个月和 12 个月时，伴随苯二氮䓬类药物、抗帕金森病药物和抗抑郁药的数量也显著减少（苯二氮䓬类药物和抗帕金森病药物 p<0.001，抗抑郁药 p<0.05）。
我们的研究表明，转换为氯氮平可能会减少抗精神病药物联合治疗的使用，并且还可能减少伴随药物的数量。
