Simon Gregory E, Rossom Rebecca C, Iturralde Esti, Ahmedani Brian K, Waring Stephen C, Owen-Smith Ashli A, Sterling Stacy A, Miley Kathleen, Stults Cheryl D, Daida Yihe G, Lynch Frances L, Beck Arne, Sanchez Katherine, Coleman Karen J, Shortreed Susan M
Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
Corresponding Author: Gregory E. Simon, MD, MPH, Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101 (
J Clin Psychiatry. 2024 Apr 29;85(2):23m14833. doi: 10.4088/JCP.23m14833.
To examine rates of clozapine use among people with psychotic disorders who experience specific indications for clozapine. Records data from 11 integrated health systems identified patients aged 18 years or older with recorded , diagnoses of schizophrenia, schizoaffective disorder, or other psychotic disorder who experienced any of the 3 events between January 1, 2019, and December 31, 2019, suggesting indications for clozapine: a diagnosis of self-harm injury or poisoning, suicidal ideation diagnosed or in response to standardized assessments, and hospitalization or emergency department (ED) care for psychotic disorder despite treatment with 2 or more antipsychotic medications. Prescription dispensing data identified all clozapine use prior to or in the 12 months following each indication event. Analyses were conducted with aggregate data from each health system; no individual data were shared. A total of 7,648 patients with psychotic disorder diagnoses experienced at least 1 indication event. Among 1,097 experiencing a self-harm event, 32 (2.9%) had any prior clozapine use, and 10 (0.9%) initiated clozapine during the following 12 months. Among 6,396 with significant suicidal ideation, 238 (3.7%) had any prior clozapine use, and 70 (1.1%) initiated clozapine over 12 months. Among 881 with hospitalization or ED visit despite pharmacotherapy, 77 (8.7%) had any prior clozapine treatment, and 41 (4.7%) initiated clozapine over 12 months. Among those with significant suicidal ideation, rates of both prior clozapine treatment and subsequent initiation varied significantly by race and ethnicity, with rates among Hispanic and non-Hispanic Black patients lower than among non Hispanic White patients. Initiating clozapine treatment is uncommon among people with psychotic disorders who experience events suggesting clozapine is indicated, with even lower rates among Black and Hispanic patients.
为了研究有使用氯氮平特定指征的精神障碍患者中氯氮平的使用比例。从11个综合医疗系统的记录数据中识别出年龄在18岁及以上、有记录的精神分裂症、分裂情感性障碍或其他精神障碍诊断的患者，这些患者在2019年1月1日至2019年12月31日期间经历了以下3种事件中的任何一种，提示有使用氯氮平的指征：自伤伤害或中毒诊断、经标准化评估诊断出的自杀意念或因自杀意念接受治疗、尽管使用了2种或更多抗精神病药物仍因精神障碍住院或到急诊科就诊。处方配药数据确定了每次指征事件之前或之后12个月内的所有氯氮平使用情况。分析使用了每个医疗系统的汇总数据；未共享个人数据。共有7648名患有精神障碍诊断的患者经历了至少1次指征事件。在1097名经历自伤事件的患者中，32名（2.9%）曾使用过氯氮平，10名（0.9%）在接下来的12个月内开始使用氯氮平。在6396名有明显自杀意念的患者中，238名（3.7%）曾使用过氯氮平，70名（1.1%）在12个月内开始使用氯氮平。在881名尽管接受了药物治疗仍住院或到急诊科就诊的患者中，77名（8.7%）曾接受过氯氮平治疗，41名（4.7%）在12个月内开始使用氯氮平。在有明显自杀意念的患者中，氯氮平既往治疗率和后续开始使用率在种族和族裔方面差异显著，西班牙裔和非西班牙裔黑人患者的使用率低于非西班牙裔白人患者。在有提示氯氮平适用的事件的精神障碍患者中，开始使用氯氮平治疗并不常见，黑人和西班牙裔患者的使用率更低。
