Department of Medical Genetics, University of Calgary, Calgary, AB, Canada.
Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Psychiatry Res. 2021 Nov;305:114247. doi: 10.1016/j.psychres.2021.114247. Epub 2021 Oct 20.
Clozapine is underutilized due, in part, to concerns about rare but severe adverse drug reactions, including cardiac inflammation and injury (myocarditis). Risk factors for clozapine-induced myocarditis are limited and predictors for the successful rechallenge of clozapine after an episode of myocarditis are even more poorly understood. We conducted a systematic review, in accordance with the PRISMA recommendation, of published case reports to describe demographic and clinical characteristics of patients with clozapine-induced myocarditis and identify potential markers of clozapine rechallenge success. A total of 180 cases from 88 articles were evaluated. Male cases of clozapine-associated myocarditis were more frequently reported than female cases by a ratio of 6:1. Less than half of patients reported the presence of chest pain (35%) or flu-like symptoms (43%) but increases in troponin or C-reactive protein were present in 87% of cases. Clozapine rechallenge was carried out in 34 (2 female) cases, with successful reintroduction in 22 (2 female) cases (64.7%) and one fatality (2.9%). No demographic or clinical markers were significantly associated with rechallenge success after correction for multiple testing. Standardized reporting of clozapine-induced myocarditis cases is needed to facilitate the identification of factors associated with successful rechallenge.
氯氮平的应用不足部分归因于对罕见但严重的药物不良反应的担忧，包括心脏炎症和损伤（心肌炎）。氯氮平诱导性心肌炎的危险因素有限，对于心肌炎发作后氯氮平重新开始使用的成功预测因素则知之甚少。我们按照 PRISMA 建议进行了系统综述，对已发表的病例报告进行了评估，以描述氯氮平诱导性心肌炎患者的人口统计学和临床特征，并确定氯氮平重新开始使用成功的潜在标志物。共有 88 篇文章中的 180 例病例进行了评估。氯氮平相关性心肌炎的男性病例比女性病例多，比例为 6:1。不到一半的患者报告有胸痛（35%）或流感样症状（43%），但 87%的病例存在肌钙蛋白或 C 反应蛋白升高。在 34 例（2 例为女性）病例中进行了氯氮平重新开始使用，22 例（2 例为女性）成功重新开始使用（64.7%），1 例死亡（2.9%）。在进行多次测试校正后，没有发现与重新开始使用成功相关的人口统计学或临床标志物。需要标准化报告氯氮平诱导性心肌炎病例，以促进识别与重新开始使用成功相关的因素。
