Özdemir Mustafa, Yıldırım Yusuf Ezel, Kart Ayşegül
Kanuni Sultan Süleyman Training and Research Hospital, Department of Psychiatry, İstanbul, Turkey.
University of Health Sciences, Bakırköy Mazhar Osman Training and Research Hospital for Psychiatric and Neurological Diseases, Department of Psychiatry, İstanbul, Turkey.
Noro Psikiyatr Ars. 2023 May 2;60(2):99-103. doi: 10.29399/npa.28317. eCollection 2023.
Clozapine may affect the outcome of severe COVID-19 infection due to its anti-inflammatory and immunosuppressant effects. This study aimed to investigate whether the risk of COVID-19 changed in schizophrenic patients using clozapine and to compare patients using clozapine with other antipsychotics in terms of COVID-19 severity.
A total of 732 patients who were registered and followed up with a diagnosis of schizophrenia were included in the study. These patients' sociodemographic data, smoking status, medications, comorbidities, COVID-19 PCR results, and COVID-19 outcomes (inpatient care admission, intensive care unit admission, death) were retrospectively analyzed.
Of the 732 patients included in our study, 177 were using clozapine. Ninety-six of 732 patients were diagnosed with COVID-19, and 34 of these were being treated with clozapine. We found that clozapine use was an independent risk factor for COVID-19 positivity (OR=1.81 95% CI=1.13-2.90), inpatient care admission (OR=3.01, 95% CI=1.12-8.06).
In our study, clozapine use was associated with an increased risk of COVID-19 positivity and inpatient care admission; however, it was not associated with ICU admission or death. Due to the frequent follow-up of patients using clozapine and the effects of clozapine on immunity, the frequency and/or identification of COVID-19 may be increased in these patients. Clozapine toxicity, granulocytopenia or agranulocytosis during the COVID-19 infection may have increased these patients' hospitalisation frequency.
氯氮平因其抗炎和免疫抑制作用，可能会影响重症 COVID-19 感染的预后。本研究旨在调查使用氯氮平的精神分裂症患者感染 COVID-19 的风险是否发生变化，并比较使用氯氮平的患者与使用其他抗精神病药物的患者在 COVID-19 严重程度方面的差异。
本研究共纳入 732 例登记并随访的精神分裂症患者。对这些患者的社会人口统计学数据、吸烟状况、用药情况、合并症、COVID-19 PCR 检测结果以及 COVID-19 结局（住院治疗、重症监护病房收治、死亡）进行回顾性分析。
在我们纳入研究的 732 例患者中，177 例使用氯氮平。732 例患者中有 96 例被诊断为 COVID-19，其中 34 例正在接受氯氮平治疗。我们发现，使用氯氮平是 COVID-19 阳性的独立危险因素（比值比=1.81，95%置信区间=1.13-2.90），也是住院治疗的独立危险因素（比值比=3.01，95%置信区间=1.12-8.06）。
在我们的研究中，使用氯氮平与 COVID-19 阳性及住院治疗风险增加相关；然而，与重症监护病房收治或死亡无关。由于对使用氯氮平的患者进行频繁随访以及氯氮平对免疫的影响，这些患者中 COVID-19 的发生率和/或检出率可能会增加。COVID-19 感染期间氯氮平的毒性、粒细胞减少或粒细胞缺乏可能增加了这些患者的住院频率。
