Mutlu Emre, Karaçam Doğan Melike, Ertuğrul Aygün, Anıl Yağcıoğlu A Elif
From the Psychiatry Clinic, Etimesgut Şehit Sait Ertürk State Hospital.
Department of Psychiatry, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
J Clin Psychopharmacol. 2022;42(3):298-307. doi: 10.1097/JCP.0000000000001526. Epub 2022 Feb 3.
Combining clozapine with a long-acting injectable antipsychotic (LAI) or using different, nonstandard formulations of the compound may improve treatment outcomes. We aimed to investigate the utility of the clozapine-LAI combination and different formulations of clozapine for compliance problems of clozapine treatment, and to describe a case series on the combined treatment.
We conducted a PubMed search with no date restriction. The number and length of hospitalizations, the results of clinical scales, and adverse events were recorded. We also present a case series of 18 patients using the clozapine-LAI combination. Data were collected from the medical charts and electronic records.
We extracted 9 records describing the use of the clozapine-LAI combination. The case reports and mirror-image studies showed a significant reduction in the number of hospitalizations, length of hospital stays, and number of visits to the emergency department on the combined treatment with no serious adverse events. We included 11 articles for clozapine formulations. The case reports and retrospective data suggested that short-acting intramuscular clozapine was often well tolerated and resulted in an increased acceptance of oral clozapine in the acute phase of illness. In our case series, illness severity and the number of hospitalization per year significantly decreased after the combined treatment, besides a significant improvement in the functioning scores. Hyperprolactinemia and extrapyramidal side effects were reported due to concomitant LAIs.
Despite the encouraging evidence, the present data are preliminary and mostly based on retrospective studies, and oral-dissolving tablets or oral liquid formulations of clozapine have insufficient evidence for clinical practice. Well-designed, controlled, follow-up studies are needed for both clozapine-LAI combination and different formulations of clozapine.
将氯氮平与长效注射用抗精神病药物（LAI）联合使用或采用该化合物的不同非标准制剂可能会改善治疗效果。我们旨在研究氯氮平-LAI联合用药及氯氮平不同制剂在氯氮平治疗依从性问题方面的效用，并描述联合治疗的病例系列。
我们对PubMed进行了无日期限制的检索。记录住院次数和时长、临床量表结果及不良事件。我们还呈现了18例使用氯氮平-LAI联合用药患者的病例系列。数据从病历和电子记录中收集。
我们提取了9条描述氯氮平-LAI联合用药的记录。病例报告和镜像研究表明，联合治疗时住院次数、住院时长及急诊就诊次数显著减少，且无严重不良事件。我们纳入了11篇关于氯氮平制剂的文章。病例报告和回顾性数据表明，在疾病急性期，短效肌内注射氯氮平通常耐受性良好，且能提高口服氯氮平的接受度。在我们的病例系列中，联合治疗后疾病严重程度和每年住院次数显著降低，功能评分也有显著改善。有报告称，因同时使用LAI出现了高催乳素血症和锥体外系副作用。
尽管有令人鼓舞的证据，但目前的数据是初步的，且大多基于回顾性研究，氯氮平口腔崩解片或口服液体制剂在临床实践中的证据不足。对于氯氮平-LAI联合用药及氯氮平不同制剂，均需要设计良好的对照随访研究。
