Moga Silvia, Teodorescu Andreea, Ifteni Petru, Petric Paula-Simina, Miron Ana-Aliana
Transilvania University of Brasov, Brasov, Romania.
Spitalul Clinic de Psihiatrie si Neurologie Brasov, Brasov, Romania.
Neuropsychiatr Dis Treat. 2022 May 4;18:977-983. doi: 10.2147/NDT.S361405. eCollection 2022.
Clozapine (CLZ) is used for treatment-resistant schizophrenia (TRS). Adverse reactions to clozapine include neutropenia. In March 2020, WHO declared the COVID-19 pandemic and after, psychiatrists raised concerns regarding continuation of clozapine, due to multiple restrictions. We aimed to provide a study on the association between neutropenia and clozapine in patients with schizophrenia and COVID-19.
To assess the neutrophil count in patients with schizophrenia treated with clozapine and infected with COVID-19.
The study patients with schizophrenia, according to DSM-5, admitted to the Clinical Hospital of Psychiatry and Neurology Brasov, Romania, between April 2020 and October 2021. The inclusion criteria included positive RT-PCR (real-time PCR) test for COVID-19 and treatment with clozapine. We assessed three values of ANC (absolute neutrophil count): before COVID-19 infection (last ANC obtained at mandatory check), during infection and 1 month after resolution (first negative PCR test).
Of the 105 cases, 95 did not have neutropenia. Fifty-nine patients were males (62.1%), mean age was 43.5 years (SD = 12.1) with an average of clozapine treatment of 52.4 months (SD = 11.9). At baseline, they had a small reduction in the ANC mean value (4.41 × 109/l; SD = 2.22) which did not constitute a statistically significant decline from the prior to COVID-19 mean value of 4.66 × 109/l (SD = 2.34; p = 0.45). Values were also normal in the first month after negative PCR testing (4.45 × 109/l; SD = 2.35; p = 0.91). A total of 10 patients (9.5%) had neutropenia. The age, dose of clozapine and duration of treatment were not statistically different compared to the group without neutropenia.
Psychiatrists and other health professionals should keep in mind that neutrophil count may decrease during COVID-19 infection in patients taking clozapine and in some cases, neutropenia may even occur. We assumed that neutropenia could be caused by COVID-19 and clozapine interaction.
氯氮平用于治疗难治性精神分裂症（TRS）。氯氮平的不良反应包括中性粒细胞减少。2020年3月，世界卫生组织宣布新冠疫情大流行，此后，由于多项限制措施，精神科医生对氯氮平的持续使用表示担忧。我们旨在研究精神分裂症合并新冠病毒感染患者中性粒细胞减少与氯氮平之间的关联。
评估接受氯氮平治疗且感染新冠病毒的精神分裂症患者的中性粒细胞计数。
本研究纳入2020年4月至2021年10月期间入住罗马尼亚布拉索夫精神病与神经病临床医院的符合《精神疾病诊断与统计手册》第5版（DSM - 5）标准的精神分裂症患者。纳入标准包括新冠病毒实时荧光定量聚合酶链反应（RT - PCR）检测呈阳性且正在接受氯氮平治疗。我们评估了中性粒细胞绝对计数（ANC）的三个值：新冠病毒感染前（在强制检查时获得的最后一次ANC）、感染期间以及症状缓解后1个月（首次PCR检测呈阴性）。
105例患者中，95例没有中性粒细胞减少。59例患者为男性（62.1%），平均年龄为43.5岁（标准差 = 12.1），氯氮平平均治疗时间为52.4个月（标准差 = 11.9）。基线时，他们的ANC平均值略有下降（4.41×10⁹/L；标准差 = 2.22），与新冠病毒感染前的平均值4.66×10⁹/L（标准差 = 2.34；p = 0.45）相比，差异无统计学意义。PCR检测呈阴性后的第一个月，数值也正常（4.45×10⁹/L；标准差 = 2.35；p = 0.91）。共有10例患者（9.5%）出现中性粒细胞减少。与无中性粒细胞减少的组相比，年龄、氯氮平剂量和治疗持续时间在统计学上无差异。
精神科医生和其他卫生专业人员应牢记，服用氯氮平的患者在新冠病毒感染期间中性粒细胞计数可能会下降，在某些情况下甚至可能出现中性粒细胞减少。我们推测中性粒细胞减少可能是由新冠病毒与氯氮平的相互作用引起的。
