Johannsen Claas-Frederik, Petersen Tonny Studsgaard, Nielsen Jimmi, Jørgensen Anders, Jimenez-Solem Espen, Fink-Jensen Anders
Mental Health Centre Copenhagen, Rigshospitalet, Edel Sauntes Allé 10, 2100 Copenhagen Ø, Denmark.
Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, DenmarkDepartment of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark.
Ther Adv Psychopharmacol. 2022 Mar 5;12:20451253211072341. doi: 10.1177/20451253211072341. eCollection 2022.
The antipsychotic drug clozapine remains underutilized partly because of the risk of life-threatening adverse effects, such as neutropenia. Therefore, an extensive hematological monitoring program was set up to detect neutropenia.
In this retrospective cohort study, we used registry-based data from the Capital Region of Denmark to investigate incidence rates of neutropenia among patients with a diagnosis of schizophrenia or other psychotic disorders and treated with clozapine for the first time. In a within-subject design, we compared rates of neutropenia in time periods where patients were exposed to clozapine time periods, where they were not exposed to clozapine. We also investigated whether the lengths of clozapine-associated neutropenia (CAN) were related to discontinuation of clozapine treatment.
Data from 520 clozapine users were included. The incidence rate of CAN was 3.2 cases per 100 person-years (95% confidence interval [CI]: 2.1-4.8) throughout the entire study. There was no significant difference in incidence rates of neutropenia during clozapine exposure and non-clozapine exposure, with an incidence rate ratio of 0.7 (95% CI: 0.4-1.3). One episode of severe neutropenia was detected. Episodes of CAN with only one sub-threshold neutrophil count were not associated with higher clozapine discontinuation (26%) than CAN episodes of more than one sub-threshold neutrophil count (28%).
In the present study, we could not confirm that clozapine treatment was associated with neutropenia.
抗精神病药物氯氮平的使用仍未得到充分利用，部分原因是存在危及生命的不良反应风险，如中性粒细胞减少症。因此，建立了广泛的血液学监测计划以检测中性粒细胞减少症。
在这项回顾性队列研究中，我们使用丹麦首都地区基于登记的数据，调查首次使用氯氮平治疗的精神分裂症或其他精神障碍患者中性粒细胞减少症的发病率。在受试者内部设计中，我们比较了患者暴露于氯氮平的时间段和未暴露于氯氮平的时间段中性粒细胞减少症的发生率。我们还调查了氯氮平相关性中性粒细胞减少症（CAN）的持续时间是否与氯氮平治疗的停药有关。
纳入了520名氯氮平使用者的数据。在整个研究中，CAN的发病率为每100人年3.2例（95%置信区间[CI]：2.1-4.8）。氯氮平暴露期间和非氯氮平暴露期间中性粒细胞减少症的发病率无显著差异，发病率比为0.7（95%CI：0.4-1.3）。检测到1例严重中性粒细胞减少症。仅有一次亚阈值中性粒细胞计数的CAN发作与氯氮平停药率较高（26%）无关，高于有不止一次亚阈值中性粒细胞计数的CAN发作（28%）。
在本研究中，我们无法证实氯氮平治疗与中性粒细胞减少症有关。
