Balbuena Lloyd, Halayka Shawn, Lee Andrew, Ahmed A G, Hinz Tamara, Kolla Nathan, Pylypow Jenna
Department of Psychiatry, University of Saskatchewan, Canada.
College of Medicine, University of Saskatchewan, Canada.
Br J Psychiatry. 2024 Dec;225(6):572-578. doi: 10.1192/bjp.2024.140.
Clozapine is the most effective medication for treatment-resistant psychoses, but the balance of benefits and risks is understudied in real-world settings.
To examine the relative re-hospitalisation rates for mental health relapse and adverse events associated with clozapine and other antipsychotics in adult and child/youth cohorts.
Data were obtained from the Canadian Institute of Health Information for adults ( = 45 616) and children/youth ( = 1476) initially hospitalised for mental health conditions in British Columbia, Manitoba and Saskatchewan from 2008 to 2018. Patient demographics and hospitalisations were linked with antipsychotic prescriptions dispensed following the initial visit. Recurrent events survival analysis for relapse and adverse events were created and compared between clozapine and other antipsychotics.
In adults, clozapine was associated with a 14% lower relapse rate versus other drugs (adjusted hazard ratio: 0.86, 95% CI: 0.83-0.90) over the 10-year follow-up. In the first 21 months, the relapse rate was higher for clozapine but then reversed. Over 1000 person-months, clozapine-treated adults could be expected to have 38 relapse hospitalisations compared with 45 for other drugs. In children/youth, clozapine had a 38% lower relapse rate compared with other antipsychotic medications (adjusted hazard ratio: 0.62, 95% CI: 0.49-0.78) over the follow-up period. This equates to 29 hospitalisations for clozapine and 48 for other drugs over 1000 person-months. In adults, clozapine had a higher risk for adverse events (hazard ratio: 1.34, 95% CI: 1.18-1.54) over the entire follow-up compared with other antipsychotics. This equates to 1.77 and 1.30 hospitalisations over 1000 person-months for clozapine and other drugs, respectively.
Clozapine was associated with lower relapse overall, but this was accompanied by higher adverse events for adults. For children/youth, clozapine was associated with lower relapse all throughout and had no difference in adverse events compared with other antipsychotics.
氯氮平是治疗难治性精神病最有效的药物，但在现实环境中其利弊平衡尚未得到充分研究。
研究氯氮平与其他抗精神病药物在成人及儿童/青少年群体中，与心理健康复发和不良事件相关的相对再住院率。
数据取自加拿大卫生信息研究所，涉及2008年至2018年在不列颠哥伦比亚省、曼尼托巴省和萨斯喀彻温省因心理健康问题首次住院的成人（n = 45616）和儿童/青少年（n = 1476）。患者人口统计学信息和住院情况与初次就诊后发放的抗精神病药物处方相关联。创建了复发和不良事件的复发事件生存分析，并在氯氮平和其他抗精神病药物之间进行比较。
在成人中，在10年的随访期内，与其他药物相比，氯氮平的复发率低14%（调整后的风险比：0.86，95%置信区间：0.83 - 0.90）。在最初的21个月里，氯氮平的复发率较高，但随后逆转。在超过1000人月的时间里，预计接受氯氮平治疗的成人有38次复发住院，而其他药物为45次。在儿童/青少年中，在随访期内，与其他抗精神病药物相比，氯氮平的复发率低38%（调整后的风险比：0.62，95%置信区间：0.49 - 0.78）。这相当于在1000人月的时间里，氯氮平有29次住院，其他药物有48次住院。在成人中，与其他抗精神病药物相比，在整个随访期内氯氮平发生不良事件的风险更高（风险比：1.34，95%置信区间：1.18 - 1.54）。这相当于在1000人月的时间里，氯氮平有1.77次住院，其他药物有1.30次住院。
氯氮平总体上与较低的复发率相关，但成人会伴随较高的不良事件发生率。对于儿童/青少年，氯氮平在整个过程中都与较低的复发率相关，并且与其他抗精神病药物相比，不良事件发生率没有差异。
