Haematological monitoring with clozapine therapy in India

International trends in clozapine use: a study in 17 countries

OBJECTIVE

There is some evidence that clozapine is significantly underutilised. Also, clozapine use is thought to vary by country, but so far no international study has assessed trends in clozapine prescribing. Therefore, this study aimed to assess clozapine use trends on an international scale, using standardised criteria for data analysis.

METHOD

A repeated cross-sectional design was applied to data extracts (2005-2014) from 17 countries worldwide.

RESULTS

In 2014, overall clozapine use prevalence was greatest in Finland (189.2/100 000 persons) and in New Zealand (116.3/100 000), and lowest in the Japanese cohort (0.6/100 000), and in the privately insured US cohort (14.0/100 000). From 2005 to 2014, clozapine use increased in almost all studied countries (relative increase: 7.8-197.2%). In most countries, clozapine use was highest in 40-59-year-olds (range: 0.6/100 000 (Japan) to 344.8/100 000 (Finland)). In youths (10-19 years), clozapine use was highest in Finland (24.7/100 000) and in the publicly insured US cohort (15.5/100 000).

CONCLUSION

While clozapine use has increased in most studied countries over recent years, clozapine is still underutilised in many countries, with clozapine utilisation patterns differing significantly between countries. Future research should address the implementation of interventions designed to facilitate increased clozapine utilisation.

Prescription practices and attitude of psychiatrists towards clozapine: A survey of psychiatrists from India

AIM

To assess the attitude of psychiatrists towards clozapine and also to evaluate the prescription practices of psychiatrists for clozapine.

METHODOLOGY

An email survey was sent to 3381 psychiatrists from India, of whom 548 (16.2%) responded.

RESULTS

Mean number of years in clinical practice was 12.59 (SD-10.1) for participating psychiatrists. Majority of the participants rated their knowledge about clozapine to be good (61.5%)/very good (34.5%). The primary indication for use of clozapine for almost all the participants was treatment resistance and most of the psychiatrists initiated clozapine either in the dose of 25mg OD (44.3%) or 12.5mg OD (37%). Half (51.8%) of the psychiatrists preferred to use clozapine as BD dosing schedule, and median doses required to stabilize the patients ranged from 137.5 to 400mg/day. Once the clozapine dose had been stabilized, about half (51%) of the psychiatrists advised blood monitoring at monthly intervals. Almost all psychiatrists rated effectiveness of clozapine to be better than other antipsychotics. In terms of tolerability, 45.3% of the psychiatrists rated it as 'same as other antipsychotics' and 15.9% rated it as better than other antipsychotics. Most common patient and therapist related factors associated with reluctance to start clozapine were history of poor medication compliance and need for monitoring, respectively. Upon reviewing the prescription of other psychiatrists, participating psychiatrists reported that in about 28.46% of patients clozapine was not prescribed though indicated.

CONCLUSIONS

This survey suggests that clozapine is underused in India, although psychiatrists have adequate knowledge about the drug but many psychiatrists have negative attitude towards clozapine.

Effectiveness of clozapine: A study from North India

BACKGROUND

There are few studies from India which have evaluated the usefulness and tolerability of clozapine from India.

AIM

To study the sociodemographic profile, clinical profile, comorbidity, side effects and outcome of subjects treated with clozapine.

METHODS AND MATERIAL

For this study, the inpatient register was screened to obtain data of all patients admitted to the psychiatric inpatient unit during January 2000 to December 2006 and who were either started or continued on clozapine. Case records of 51 patients were taken up for the study.

RESULTS

Majority of the patients who were started on clozapine were male (80.4%), single (70.6%), unemployed (70.6%), educated up to or beyond 10 years of schooling (86.3%) and belonged to nuclear families (64.7%). More than three-fourth's of them had received two or more adequate antipsychotic trials before being considered for clozapine. The mean dose of clozapine was 298.97mg/day. During the inpatient stay (mean duration 63 days), there was significant reduction (34.7%) in PANSS rating after starting clozapine. Sialorrhoea was the most common side effect, reported by 58.8% of subjects. In terms of long term outcome at a mean duration of 3.99 (SD 3.13) years after starting clozapine, 37 cases were on clozapine at the time of last follow-up. While receiving clozapine, three cases developed leucopenia and four patients developed seizures.

CONCLUSION

Clozapine leads to reduction in psychopathology and sialorrhoea is the most common side effect reported.