South Metropolitan Health Service, Peel and Rockingham Kwinana (PaRK) Mental Health Service, Rockingham, Western Australia, 6168, Australia.
Division of Psychiatry, School of Medicine, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia.
Schizophr Bull. 2023 Jan 3;49(1):53-67. doi: 10.1093/schbul/sbac148.
BACKGROUND/OBJECTIVES: There have been concerns that clozapine treatment may undermine the capacity of the body to fight infection and increase the vulnerability to contracting COVID-19. This review of recent cohort studies investigated (1) whether people with a severe psychiatric disorder are at increased risk of COVID-19 and complications, (2) the immunological response of clozapine-users who contract COVID-19, and (3) patients' perspectives on COVID-19 and the pandemic response.
A systematic search of EMBASE, Medline, Pubmed, and PsycINFO databases using PRISMA guidelines using "COVID-19", "clozapine", and "vaccination" terms.
18 studies (out of 330 identified) met all criteria (N = 119 054 including 8045 on clozapine). There was no strong evidence that clozapine users may be at increased risk of contracting COVID-19 or developing complications after adjusting for medical comorbidities. Hematological studies showed temporary reductions in neutrophils in COVID-19-positive patients and vaccination suggesting a clozapine effect in defence against infection. Vaccination studies did not report major adverse effects. Increased plasma levels of clozapine and neutropenia however point to COVID-19-related interference of clozapine metabolism. Patient surveys reported limited impact on mental health and positive attitudes regarding pandemic response.
This review did not find compelling evidence that the immune system of clozapine users put them at risk of COVID-19 and further complications. Evidence of drug-infection interactions however points to the importance of adhering to consensus guidelines about clozapine therapy during the pandemic. More evidence using longitudinal designs is required to examine the longer-term effects of COVID-19 and vaccination in this vulnerable population.
背景/目的：人们担心氯氮平治疗可能会削弱身体抗感染的能力，并增加感染 COVID-19 的风险。本综述对最近的队列研究进行了调查，（1）患有严重精神疾病的人是否有更高的 COVID-19 和并发症风险，（2）感染 COVID-19 的氯氮平使用者的免疫反应，以及（3）患者对 COVID-19 和大流行应对措施的看法。
使用 PRISMA 指南，通过 EMBASE、Medline、Pubmed 和 PsycINFO 数据库进行系统搜索，使用“COVID-19”、“氯氮平”和“疫苗接种”术语。
18 项研究（在 330 项研究中）符合所有标准（N = 119054 人，其中 8045 人服用氯氮平）。在调整了医疗合并症后，没有强有力的证据表明氯氮平使用者可能会增加感染 COVID-19 或出现并发症的风险。血液学研究表明，COVID-19 阳性患者的中性粒细胞和疫苗接种后的中性粒细胞暂时减少，这表明氯氮平在抗感染方面具有作用。疫苗接种研究未报告主要不良反应。然而，氯氮平水平升高和中性粒细胞减少表明 COVID-19 可能会干扰氯氮平的代谢。患者调查报告对心理健康的影响有限，并对大流行应对措施持积极态度。
本综述没有发现令人信服的证据表明氯氮平使用者的免疫系统使他们面临 COVID-19 和进一步并发症的风险。然而，药物-感染相互作用的证据表明，在大流行期间遵循氯氮平治疗的共识指南非常重要。需要使用纵向设计来获得更多证据，以检查 COVID-19 和疫苗接种对这一脆弱人群的长期影响。
