Universitatea Transilvania, Braşov, Romania; and.
Spitalul Clinic de Psihiatrie şi Neurologie Braşov, Braşov, Romania.
Am J Ther. 2022;29(5):e544-e552. doi: 10.1097/MJT.0000000000001532. Epub 2022 Jun 24.
Clozapine is the only approved antipsychotic for treatment-resistant schizophrenia. Despite its therapeutic benefits, it is still widely underused, mainly because of its potential to cause agranulocytosis and neutropenia. Prescribing clozapine in COVID-19-positive patients became more challenging because of this potential side effect. This article is a review of literature on the risk of neutropenia associated with clozapine treatment in patients with COVID-19.
In clozapine-treated COVID-19-positive patients, neutropenia was reported in some cases; is it a consequence of clozapine treatment or of SARS-Co2 infection?
Data were extracted from 2 databases: PubMed/MEDLINE and Google Scholar. We selected all original reports, from March 2020 until May 2022, on neutropenia associated with clozapine treatment in positive COVID-19 patients. Eleven studies were selected for the final analysis.
Before the COVID-19 pandemic, neutropenia in clozapine-treated patients was reported in 3.8% of cases. During the pandemic, neutropenia rates seemed to be higher. As per the cause of neutropenia, studies reported contradictory results. We aim to clarify rates and causes of neutropenia in clozapine-treated COVID-19-positive patients.
Three hundred eighty-eight articles were initially selected from the 2 databases. After excluding duplicates, unrelated articles, reviews, and guidelines, 11 studies were analyzed, all centered on clozapine treatment, COVID-19 infection, and associated neutropenia.
Clozapine treatment in COVID-19-positive patients may be associated with a transient reduction of absolute neutrophils count, in some cases reaching neutropenia levels. Neutropenia rates reported in SARS-CoV-2-infected patients are higher than the prepandemic reports; therefore, we assume that the cause might be a result of the immunological interference between clozapine and SARS-CoV-2. Clozapine treatment needs to be continued whenever possible, with dose adjustments in relation to blood test results.
氯氮平是治疗耐药性精神分裂症的唯一批准的抗精神病药。尽管它具有治疗益处，但它仍然广泛未被使用，主要是因为它有引起粒细胞缺乏症和中性粒细胞减少症的潜力。由于这种潜在的副作用，在 COVID-19 阳性患者中开氯氮平处方变得更加具有挑战性。本文是对氯氮平治疗 COVID-19 患者中性粒细胞减少症相关风险的文献综述。
在接受氯氮平治疗的 COVID-19 阳性患者中，一些患者报告出现了中性粒细胞减少症；这是氯氮平治疗的结果还是 SARS-Co2 感染的结果？
数据从 2 个数据库中提取：PubMed/MEDLINE 和 Google Scholar。我们选择了所有 2020 年 3 月至 2022 年 5 月期间关于 COVID-19 阳性患者中氯氮平治疗相关中性粒细胞减少症的原始报告。最终分析中选择了 11 项研究。
在 COVID-19 大流行之前，接受氯氮平治疗的患者中性粒细胞减少症的报告率为 3.8%。在大流行期间，中性粒细胞减少症的比率似乎更高。关于中性粒细胞减少症的原因，研究报告了相互矛盾的结果。我们旨在澄清氯氮平治疗 COVID-19 阳性患者中性粒细胞减少症的发生率和原因。
从这两个数据库中最初筛选出 388 篇文章。排除重复项、不相关的文章、综述和指南后，分析了 11 项研究，这些研究都集中在氯氮平治疗、COVID-19 感染和相关中性粒细胞减少症上。
在 COVID-19 阳性患者中使用氯氮平治疗可能与绝对中性粒细胞计数的短暂降低有关，在某些情况下，中性粒细胞计数会降至中性粒细胞减少症水平。在 SARS-CoV-2 感染患者中报告的中性粒细胞减少症发生率高于大流行前的报告；因此，我们假设原因可能是氯氮平与 SARS-CoV-2 之间的免疫干扰。只要可能，仍需继续使用氯氮平治疗，并根据血液检查结果调整剂量。
