The prevalence of agranulocytosis and related death in clozapine-treated patients: a comprehensive meta-analysis of observational studies

@article{Li2019ThePO,
  title={The prevalence of agranulocytosis and related death in clozapine-treated patients: a comprehensive meta-analysis of observational studies},
  author={Xiaohong Li and Xiao-Mei Zhong and Li Lu and Wei Zheng and Shi-bin Wang and Wen-Wang Rao and Shuai Wang and Chee H. Ng and Gabor S. Ungvari and Gang Wang and Yutao Xiang},
  journal={Psychological Medicine},
  year={2019},
  volume={50},
  pages={583 - 594}
}
Abstract Background Clozapine treatment increases the risk of agranulocytosis, but findings on the epidemiology of agranulocytosis have been inconsistent. This meta-analysis examined the prevalence of agranulocytosis and related death in clozapine-treated patients. Methods A literature search in the international (PubMed, PsycINFO, and EMBASE) and Chinese (WanFang, Chinese National Knowledge Infrastructure, and Sinomed) databases was conducted. Prevalence estimates of agranulocytosis and… 

Pharmacogenomics of Clozapine-induced agranulocytosis: a systematic review and meta-analysis

It is suggested that a predictive HLA-DRB1*04:02-based pharmacogenomic test may be promising for clinical implementation but requires further investigation.

Clozapine-Associated Leukopenia and Agranulocytosis in Western Cape, South Africa

The incidence of clozapine-induced HSEs was lower than previously reported and not significantly different compared with risperidone, and HIV infection was associated with H SEs.

Clozapine-induced agranulocytosis

A review of the epidemiology of clozapine-induced agranulocytosis (CLIA), advances in identifying genetic risk factors, and the preventive measures to reduce the risk of CLIA is presented.

Reduction in Absolute Neutrophil Counts in Patient on Clozapine Infected with COVID-19

COVID-19 is associated with a temporary reduction in ANC levels, which supported the recommendation to reduce the frequency of clozapine monitoring in the eligible candidates, but more data are required to confirm the current findings given the limitations.

Clozapine Therapy and COVID-19: A Systematic Review of the Prevalence Rates, Health Outcomes, Hematological Markers, and Patient Perspectives

This review did not find compelling evidence that the immune system of clozapine users put them at risk of COVID-19 and further complications, but evidence of drug–infection interactions however points to the importance of adhering to consensus guidelines about clozAPine therapy during the pandemic.

Frequency of neutropenia over time in patients on clozapine

A contrast is found between the relatively high density of the confirmed red results at the beginning of clozapine treatment which significantly reduces after 6 months of treatment which remained low thereafter.

Incident infection during the first year of treatment – A comparison of clozapine and paliperidone palmitate long-acting injection

Patients starting clozapine showed a substantially increased likelihood of infection compared with patients starting PPLAI, although the majority of infections were non-chest-related.

Clozapine re-challenge and initiation following neutropenia: a review and case series of 14 patients in a high-secure forensic hospital

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.

A Decrease of Neutrophils After COVID-19 Vaccination in a Treatment-Resistant Patient With Schizophrenia Taking Clozapine

A TRS patient with 5 years' CLZ administration who showed a transient decrease of the absolute white blood cell (WBC) count and ANC after administration of COVID-19 vaccinations (Pfizer/ BioNTech) is experienced.

A Rational Use of Clozapine Based on Adverse Drug Reactions, Pharmacokinetics, and Clinical Pharmacopsychology

Rational use requires modification of the clozapine package insert worldwide to include lower doses for Asians and to avoid the lethality associated with pneumonia, the use of clozAPine levels for personalizing dosing, and theUse of slow and personalized titration to make clozabine as safe as possible and contribute to increased life expectancy and well-being.

References

SHOWING 1-10 OF 96 REFERENCES

Effects of the clozapine national registry system on incidence of deaths related to agranulocytosis.

The clozapine national registry system fostered early detection of white blood cell suppression, prevented retreatment with clozAPine of patients who had previously developed white bloodcell suppression, and brought about lower than expected rates of agranulocytosis and associated deaths.

Clozapine-associated neutropenia and agranulocytosis in Argentina (2007–2012)

With monitoring by international standards, recent risks of clozapine-associated agranulocytosis in Argentina were lower, but fatality rates were higher than that in other regions of the world.

Neutropenia and Agranulocytosis in Patients Receiving Clozapine in the UK and Ireland

The use of a patient monitoring service kept the haematological risks associated with using clozapine within acceptable limits, particularly in view of the benefits of this medication in treatment-resistant schizophrenia.

Agranulocytosis in Bangkok, Thailand: a predominantly drug-induced disease with an unusually low incidence. Aplastic Anemia Study Group.

The incidence of agranulocytosis in Bangkok, and apparently, in Thailand as a whole, is unusually low, and the disease does not pose a public health risk.

HLA-B38 and clozapine-induced agranulocytosis in Israeli Jewish schizophrenic patients.

  • A. ValevskiT. Klein Abraham Weizman
  • Medicine, Psychology
    European journal of immunogenetics : official journal of the British Society for Histocompatibility and Immunogenetics
  • 1998
HLA typing was performed in 61 Jewish Israeli schizophrenic patients to suggest that major histocompatibility complex gene products could be involved in clozapine-mediated haematological complications.

Clozapine-induced agranulocytosis. Incidence and risk factors in the United States.

The increasing risk of agranulocytosis with age and the reduced incidence after the first six months of treatment provide additional guidelines for the prescription and monitoring of clozapine treatment in the future.

Clozapine-induced agranulocytosis is associated with rare HLA-DQB1 and HLA-B alleles

Two loci in the major histocompatibility complex are independently associated with clozapine-induced agranulocytosis/granulocytopenia (CIAG), and these associations dovetail with the roles of these genes in immunogenetic phenotypes and adverse drug responses for other medications, and provide insight into the pathophysiology of CIAG.

Neutropenia and Agranulocytosis in Chinese Patients Prescribed Clozapine.

  • K. LauP. H. Yim
  • Medicine, Psychology
    East Asian archives of psychiatry : official journal of the Hong Kong College of Psychiatrists = Dong Ya jing shen ke xue zhi : Xianggang jing shen ke yi xue yuan qi kan
  • 2015
Long-term monitoring of white cell count is necessary during clozapine treatment and the concurrent use of clozAPine with other potentially leukopenic psychotropic drugs should be limited.

HLA-B38, DR4, DQw3 and clozapine-induced agranulocytosis in Jewish patients with schizophrenia.

It is postulate that gene products contained in the haplotype may be involved in mediating drug toxicity and genetic factors marked by major histocompatibility complex haplotypes may be associated with the susceptibility of Jewish schizophrenic patients treated with clozapine to develop agranulocytosis.

Blood dyscrasias in clozapine-treated patients in Italy.

The ICLOS study confirms that regular hematologic monitoring is highly effective in minimizing the incidence of clozapine-associated blood dyscrasias, and the lower than initially expected rates of agranulocytosis and associated deaths are encouraging in view of the benefits of this drug in treatment-resistant schizophrenia and other neurologic disorders.
...