Clozapine's effectiveness for patients in state hospitals: results from a randomized trial.

In our study, we examined the effectiveness of clozapine and compared it to the array of medication alternatives typically used in the public sector. Long-term patients in Connecticut's state hospitals who met Food and Drug Administration criteria for clozapine use were invited to participate in this randomized open-label study. Participants (N = 227) were followed for 2 years. Compared with usual care, clozapine was associated with significantly greater reductions in side effects, disruptiveness, and hospitalization, but was not more effective in reducing symptoms or improving quality of life. The groups did not differ in likelihood of being discharged; however, once discharged, clozapine patients were less likely to be readmitted. The results of our study suggest that, compared with the flexible range of medication alternatives available, clozapine is an effective agent. However, at least with this patient population, clozapine did not produce the dramatic improvements is symptomatology or hospital utilization reported in clinical efficacy trials or suggested by mirror-image studies.