Department of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.
Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy.
J Psychopharmacol. 2021 Sep;35(9):1062-1073. doi: 10.1177/02698811211021587. Epub 2021 May 27.
The drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a drug-induced hypersensitivity reaction.
Aim was to review reports of clozapine-related reactions fulfilling the registry of severe cutaneous adverse reaction (RegiSCAR) criteria for DRESS syndrome reported as such or otherwise, to provide a descriptive overview of demographic patterns, clinical manifestations, and DRESS course and investigate associations between demographic, DRESS parameters, and clinical outcomes.
This review was conducted following preferred reporting items for systematic reviews and meta-analyses guidelines and registered with PROSPERO (registration number CRD42020156385). We searched PubMed/Embase/PsychInfo/Cochrane for reports of clozapine-related reactions meeting RegiSCAR criteria. Associations between RegiSCAR scores and time-to-recovery with demographic/clinical variables were assessed. Demographic/clinical characteristics of patients with versus without reported DRESS were compared using non-parametrical tests.
We identified 26 reports of 27 patients meeting RegiSCAR criteria. Males ( = 19, 70.4%) and patients with schizophrenia ( = 18, 66.7%) were mainly affected. Twelve patients (44.4%) received clozapine-monotherapy. DRESS symptoms manifested within a month after clozapine initiation ( = 24, 88.9%). Lungs and liver were the most common organs involved ( = 12, 44.4%; = 11, 40.7%), with a mean time to recovery of 33.75 days. Clozapine rechallenge led to DRESS recurrence in four patients. Death rate was 7.4%. No associations were detected between RegiSCAR criteria or days to recovery with any demographic/clinical variables. No differences between patients with versus without reported DRESS were detected.
Clozapine-related DRESS may be rare, but also underreported. Clinicians need to be aware of it even in patients under clozapine-monotherapy or without skin rash.
药物反应伴嗜酸性粒细胞增多和全身症状（DRESS）综合征是一种药物引起的超敏反应。
旨在回顾符合严重皮肤不良反应登记处（RegiSCAR）DRESS 综合征标准的氯氮平相关反应报告，无论是以 DRESS 综合征报告还是其他方式报告，提供人口统计学模式、临床表现和 DRESS 病程的描述性概述，并调查人口统计学、DRESS 参数和临床结果之间的关联。
本综述遵循系统评价和荟萃分析的首选报告项目指南，并在 PROSPERO（注册号 CRD42020156385）中进行了注册。我们在 PubMed/Embase/PsychInfo/Cochrane 中搜索符合 RegiSCAR 标准的氯氮平相关反应报告。评估 RegiSCAR 评分与恢复时间与人口统计学/临床变量之间的关联。使用非参数检验比较有/无报告 DRESS 的患者的人口统计学/临床特征。
我们确定了符合 RegiSCAR 标准的 27 例患者的 26 份报告。男性（ = 19，70.4%）和精神分裂症患者（ = 18，66.7%）受影响最大。12 名患者（44.4%）接受氯氮平单药治疗。DRESS 症状在氯氮平开始后一个月内出现（ = 24，88.9%）。肺部和肝脏是最常见的受累器官（ = 12，44.4%； = 11，40.7%），平均恢复时间为 33.75 天。氯氮平再挑战导致 4 例患者出现 DRESS 复发。死亡率为 7.4%。RegiSCAR 标准或恢复天数与任何人口统计学/临床变量之间均未检测到关联。未发现有报告的 DRESS 患者与无报告的 DRESS 患者之间存在差异。
氯氮平相关 DRESS 可能很少见，但也可能报告不足。即使在接受氯氮平单药治疗或无皮疹的患者中，临床医生也需要对此有所认识。
