Clozapine Rechallenge After Major Adverse Effects: Clinical Guidelines Based on 259 Cases

@article{Manu2018ClozapineRA,
  title={Clozapine Rechallenge After Major Adverse Effects: Clinical Guidelines Based on 259 Cases},
  author={Peter Manu and Yevgeniya Lapitskaya and Atef Shaikh and Jimmi Nielsen},
  journal={American Journal of Therapeutics},
  year={2018},
  volume={25},
  pages={e218–e223}
}
Background: Clozapine is widely prescribed for treatment-refractory schizophrenia, but its use is limited by many potentially life-threatening adverse effects. The risk of rechallenge after these complications has never been comprehensively assessed in controlled studies. Thus, clinical guidelines must rely on the published case reports. The number of such reports is likely to increase over time, and updated analyses of larger samples are needed, as they may lead to changes in clinical… 
Clozapine Rechallenge or Continuation Despite Neutropenia, an Extended Follow-up of a Consecutive Quebec Case Series
TLDR
This study aimed to describe consecutively the evolution of every patient in the Québec City catchment area for whom clozapine was either reintroduced after neutropenia during a previous clozAPine trial or was maintained despite a first neutropania.
CLOZAPINE RECHALLENGE WITH LITHIUM AFTER DOUBLE INDUCED NEUTROPENIA: A CASE REPORT
TLDR
More research is needed on the matter in the interest of a better quality of life for treatment resistant schizophrenia patients, as evidence suggest rechallenging after clozapine-induced neutropenia.
Clozapine Is Better Tolerated in Younger Patients: Risk Factors for Discontinuation from a Nationwide Database in Japan
TLDR
Careful administration of clozapine to patients with intolerance to olanzapine, previous treatment with clozAPine, and leukocyte counts is important because patients with these factors have a high risk of discontinuation.
Clozapine-Related Myocarditis and Rechallenge: A Case Series and Clinical Review.
TLDR
Pressure to undertake a rechallenge reflects clozapine's unique role in treatment-resistant schizophrenia and absence of other comparable options, but it is not without risk, and more research is needed to understand those at increased risk, as well as established strategies that diminish this.
Clozapine re-challenge and initiation following neutropenia: a review and case series of 14 patients in a high-secure forensic hospital
TLDR
Even in this extreme group of patients with treatment resistant schizophrenia, clozapine can be safely and effectively re/initiated following neutropenias, resulting in marked benefits for patients, according to a case series of 14 consecutive patients rechallenged in a high-secure psychiatric hospital.
Successful clozapine rechallenge after myopericarditis: a case report.
TLDR
Given the unique role of clozapine in the management of TRS, clozAPine rechallenge may be considered after pericarditis, even with troponin levels elevation.
In the aftermath of clozapine discontinuation: comparative effectiveness and safety of antipsychotics in patients with schizophrenia who discontinue clozapine
TLDR
Clozapine and olanzapine are the most effective and safest treatment options in patients with schizophrenia who previously discontinued this compound, and should be reconsidered in patients who previously discontinued this compound.
Clozapine rechallenge following neutropenia using granulocyte colony-stimulating factor: A Quebec case series
TLDR
The results suggest that the "as-needed" use of G-CSF is well-tolerated and may allow clozapine rechallenge in some well-selected patients, adding to the paucity of data regarding long-term safety and efficacy of this strategy.
Protocol for Clozapine Rechallenge in a Case of Clozapine-Induced Myocarditis
TLDR
A successful clozapine rechallenge protocol is developed, based on careful monitoring of changes in these indices and a very slow clozabine re-titration, which may have utility in the management of patients with a history of clozAPine-induced myocarditis.
Clozapine in the treatment of refractory schizophrenia: a practical guide for healthcare professionals
TLDR
There is a need for better management of serious clozapine-related adverse events in addition to agranulocytosis, and better education of patients and carers, general practitioners, A&E and ITU staff and others of the problems posed in using clozAPine safely.
...
...

References

SHOWING 1-10 OF 84 REFERENCES
Rechallenging with clozapine following neutropenia: treatment options for refractory schizophrenia.
TLDR
It is proposed that polypharmacy may have contributed to the initial episode of neutropenia as well as the failed clozapine rechallenge in a patient with refractory schizophrenia.
Clozapine Rechallenge After Neutropenia or Leucopenia
TLDR
Almost 70% of the patients rechallenged with clozapine after a leucopenia or a neutropenia did not develop a new hematological adverse effect, whereas the remaining 30% had a faster but less serious neutropania.
Optimizing outcomes in clozapine rechallenge following neutropenia: a cohort analysis.
TLDR
In this selected population, the initial neutropenia was unlikely to be related to clozapine in a substantial proportion of cases, and this group was successfully rechallenged following careful consideration of the risks and benefits.
Successful rechallenge with clozapine after treatment associated eosinophilia
TLDR
It is believed that the current report provides further evidence that it may be unnecessary to cease treatment in all patients who develop an eosinophilia without organ dysfunction whilst on clozapine.
Rechallenge with clozapine following leucopenia or neutropenia during previous therapy
TLDR
No clear risk factor for repeat blood dyscrasias was identified and after risks and benefits have been considered, rechallenge may well be justified in some patients.
Development of Atrial Flutter After Initiation of Clozapine and Successful Rechallenge Without Recurrence.
TLDR
The case of a patient with newly developed atrial flutter after titration of clozapine in which the arrhythmia was medically managed to allow for successful rechallenge of clazapine is presented.
Recurrent pancreatitis without eosinophilia on clozapine rechallenge
Clozapine-Induced Systemic Lupus Erythematosus
TLDR
A classic case of clozapine-induced lupus that, according to the Naranjo probability scale, demonstrates a highly probable relationship between DIL and clozAPine.
...
...