McMahon Laura, Giudice Maddison, Wagner Elias, Hasan Alkomiet, Burrage Matthew K, Amerena John, Fox Cooper, Winckel Karl, Tanzer Timothy, Smith Lesley, Warren Nicola, Siskind Dan, Korman Nicole
Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
Mental Health Service, Darling Downs Health District, Toowoomba, QLD, Australia.
CNS Spectr. 2024 Dec;29(6):585-592. doi: 10.1017/S1092852924002219. Epub 2024 Dec 20.
Clozapine is the antipsychotic medication with the greatest efficacy in treatment-resistant schizophrenia (TRS). Unfortunately, clozapine is ceased in approximately 0.2% to 8.5% of people due to concerns about clozapine-associated myocarditis (CAM). The opportunity for clozapine rechallenge is important for people with TRS and CAM, due to limited alternative treatments. However, there is a lack of consensus regarding the optimal process, monitoring, and dose titration to achieve successful clozapine rechallenge. The study aimed to review the process, monitoring, and dose titration within cases of clozapine rechallenge after CAM, to identify features associated with successful rechallenge.
A systematic review of clozapine rechallenge cases following CAM was conducted. PubMed, EMBASE, Cinahl, and PsycINFO were searched for cases. Reference lists of retrieved articles and field experts were consulted to identify additional studies.
Forty-five cases were identified that described clozapine rechallenge, 31 of which were successful. Successful rechallenge cases generally used a slower dose titration regime with more frequent monitoring than standard clozapine initiation protocols; however, this data was not always completely recorded within cases. Six cases referred to published rechallenge protocols to guide their rechallenge.
The process, monitoring, and dose titration of clozapine rechallenge are inconsistently reported in the literature. Despite this, 69% of case reports detailed a successful rechallenge post CAM; noting limitations associated with reliance on case data. Ensuring published clozapine rechallenge cases report standardised data, including titration speed and monitoring frequencies, is required to guide the development and validation of guidelines for clozapine rechallenge.
氯氮平是治疗难治性精神分裂症（TRS）疗效最佳的抗精神病药物。遗憾的是，由于担心氯氮平相关性心肌炎（CAM），约0.2%至8.5%的患者停用了氯氮平。对于TRS和CAM患者而言，重新使用氯氮平的机会很重要，因为替代治疗有限。然而，对于实现成功重新使用氯氮平的最佳流程、监测和剂量滴定，目前尚无共识。本研究旨在回顾CAM后重新使用氯氮平病例的流程、监测和剂量滴定情况，以确定与成功重新使用相关的特征。
对CAM后重新使用氯氮平的病例进行系统综述。在PubMed、EMBASE、Cinahl和PsycINFO中检索相关病例。查阅检索文章的参考文献列表并咨询领域专家，以确定其他研究。
共识别出45例描述重新使用氯氮平的病例，其中31例成功。成功重新使用的病例通常采用比标准氯氮平起始方案更慢的剂量滴定方式，并进行更频繁的监测；然而，这些数据在病例中并非总是完整记录。有6例参考了已发表的重新使用方案来指导其重新使用。
文献中关于氯氮平重新使用的流程、监测和剂量滴定的报道不一致。尽管如此，69%的病例报告详细描述了CAM后成功重新使用氯氮平的情况；同时指出了依赖病例数据的局限性。为指导氯氮平重新使用指南的制定和验证，需要确保已发表的氯氮平重新使用病例报告标准化数据，包括滴定速度和监测频率。
