Liu Jian, Zhao Weimin, Wang Yitong
College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Jilin, China.
Department of Preventive Medicine, The Affiliated Hospital of Changchun University of Chinese Medicine, Jilin, China.
Metab Brain Dis. 2025 Feb 15;40(2):128. doi: 10.1007/s11011-025-01558-1.
Schizophrenia is a chronic mental disorder and one of the main causes of disability in the world. Approximately 1% of the general population suffers from this disorder, and almost 30% of cases are unresponsive to antipsychotic therapies. Clozapine is a Food and Drug Administration (FDA)-approved antipsychotic drug for treatment-resistant schizophrenia (TRS). Clozapine is also approved for the prevention of suicide associated with schizophrenia. However, clozapine is not the preferred first-line medication because of its potential AEs, including agranulocytosis, metabolic syndromes, and myocarditis. Clozapine prescription requires weekly absolute neutrophil count (ANC) monitoring for the first six months, followed by biweekly monitoring until the patient has finished one year of treatment. Several psychiatric disorders have been reported to be associated with inflammatory biomarkers. Dysregulation of the immune system and the elevation of pro-inflammatory cytokines were also reported to be associated with schizophrenia, highlighting the necessity of further research into the etiology of the disease and the relationship between the immune system and clozapine-responsiveness to support better management of symptoms and potential AEs. In this framework, we searched PubMed using the medical subject headings (MeSH) terms "clozapine", "antipsychotics", "schizophrenia", "treatment-resistant schizophrenia", "immune system", "inflammation", "neuroinflammation", "biomarker", "cytokine", and "chemokine" with the aim of overview the impact of clozapine on the immune system in individuals with treatment-responsive and treatment-resistant schizophrenia.
精神分裂症是一种慢性精神障碍，也是全球致残的主要原因之一。普通人群中约1%患有这种疾病，近30%的病例对抗精神病药物治疗无反应。氯氮平是一种经美国食品药品监督管理局（FDA）批准用于治疗难治性精神分裂症（TRS）的抗精神病药物。氯氮平也被批准用于预防与精神分裂症相关的自杀行为。然而，由于氯氮平存在包括粒细胞缺乏症、代谢综合征和心肌炎等潜在不良反应，它并非首选的一线药物。氯氮平处方要求在开始治疗的前六个月每周监测绝对中性粒细胞计数（ANC），之后每两周监测一次，直至患者完成一年的治疗。据报道，几种精神疾病与炎症生物标志物有关。免疫系统失调和促炎细胞因子升高也被报道与精神分裂症有关，这凸显了进一步研究该疾病病因以及免疫系统与氯氮平反应性之间关系的必要性，以更好地管理症状和潜在不良反应。在此框架下，我们在PubMed数据库中使用医学主题词（MeSH）“氯氮平”“抗精神病药物”“精神分裂症”“难治性精神分裂症”“免疫系统”“炎症”“神经炎症”“生物标志物”“细胞因子”和“趋化因子”进行检索，旨在综述氯氮平对治疗反应性和难治性精神分裂症患者免疫系统的影响。
