PDF(Pubmed)
Abstract：
UNASSIGNED: Clozapine is the only antipsychotic approved for treatment-resistant schizophrenia, but without appropriate monitoring, it can be associated with potentially fatal outcomes. An International Adult Clozapine Titration Guideline categorizes patients into normal or slow metabolizers. Categorization provides clozapine titration schedules and recommends regular c-reactive protein (CRP) and clozapine concentration monitoring to reduce the risk of adverse drug reactions (ADRs). The impact of the guideline on clozapine ADRs has not been evaluated.
UNASSIGNED: A retrospective chart review assessed clozapine titrations, laboratory monitoring, ADRs, and discontinuations for clozapine-naive adult inpatients at a single center from January 1, 2013, to June 1, 2022. Each patient\'s cumulative weekly clozapine dosage was compared with their guideline recommended dosage to create a percent accordance. Linear logistic regression evaluated the relationship between titration speed and the presence of an ADR, while descriptive statistics analyzed laboratory monitoring.
UNASSIGNED: Forty-three patients were included, with the majority being White males with schizophrenia. An inverse relationship existed between the last inpatient week clozapine dose percent accordance and the probability of an ADR. Nonobese patients were less likely than obese patients to experience an ADR (odds ratio = 0.17; 95% CI, 0.03-0.99). CRP and clozapine concentration monitoring was suboptimal.
UNASSIGNED: Based on our small retrospective review of primarily White males, more aggressive clozapine titrations did not increase ADRs. Future studies with more diverse samples are needed and should focus on specific ADRs, which may have increased occurrence with rapid titrations. Obese patients were at higher risk of ADRs, correlating with the guideline-recommended slower titrations for these patients.
UNASSIGNED: A retrospective chart review assessed clozapine titrations, laboratory monitoring, ADRs, and discontinuations for clozapine-naive adult inpatients at a single center from January 1, 2013, to June 1, 2022. Each patient\'s cumulative weekly clozapine dosage was compared with their guideline recommended dosage to create a percent accordance. Linear logistic regression evaluated the relationship between titration speed and the presence of an ADR, while descriptive statistics analyzed laboratory monitoring.
UNASSIGNED: Forty-three patients were included, with the majority being White males with schizophrenia. An inverse relationship existed between the last inpatient week clozapine dose percent accordance and the probability of an ADR. Nonobese patients were less likely than obese patients to experience an ADR (odds ratio = 0.17; 95% CI, 0.03-0.99). CRP and clozapine concentration monitoring was suboptimal.
UNASSIGNED: Based on our small retrospective review of primarily White males, more aggressive clozapine titrations did not increase ADRs. Future studies with more diverse samples are needed and should focus on specific ADRs, which may have increased occurrence with rapid titrations. Obese patients were at higher risk of ADRs, correlating with the guideline-recommended slower titrations for these patients.
摘要：
■氯氮平是唯一被批准用于治疗难治性精神分裂症的抗精神病药物，但是如果没有适当的监控，它可能与潜在的致命结果有关.国际成人氯氮平滴定指南将患者分为正常或慢代谢者。分类提供了氯氮平滴定时间表，并建议定期进行C反应蛋白（CRP）和氯氮平浓度监测，以降低药物不良反应（ADR）的风险。该指南对氯氮平不良反应的影响尚未评估。
■回顾性图表评估了氯氮平的滴定，实验室监测,美国存托凭证，从2013年1月1日至2022年6月1日，在单个中心停药了未使用氯氮平的成年住院患者。将每位患者的每周累积氯氮平剂量与他们的指南推荐剂量进行比较，以创建百分比。线性逻辑回归评估了滴定速度与ADR存在之间的关系，而描述性统计分析了实验室监测。
■包括43名患者，大多数是患有精神分裂症的白人男性。最后一周住院的氯氮平剂量百分比与ADR的可能性之间存在反比关系。与肥胖患者相比，非肥胖患者发生ADR的可能性较小（比值比=0.17；95％CI，0.03-0.99）。CRP和氯氮平浓度监测欠佳。
■根据我们对白人男性的小型回顾性研究，更积极的氯氮平滴定不会增加ADR.未来的研究需要更多不同的样本，应该集中在特定的ADR，快速滴定可能会增加发生率。肥胖患者ADR的风险更高，与指南推荐的这些患者的慢滴定相关。
■回顾性图表评估了氯氮平的滴定，实验室监测,美国存托凭证，从2013年1月1日至2022年6月1日，在单个中心停药了未使用氯氮平的成年住院患者。将每位患者的每周累积氯氮平剂量与他们的指南推荐剂量进行比较，以创建百分比。线性逻辑回归评估了滴定速度与ADR存在之间的关系，而描述性统计分析了实验室监测。
■包括43名患者，大多数是患有精神分裂症的白人男性。最后一周住院的氯氮平剂量百分比与ADR的可能性之间存在反比关系。与肥胖患者相比，非肥胖患者发生ADR的可能性较小（比值比=0.17；95％CI，0.03-0.99）。CRP和氯氮平浓度监测欠佳。
■根据我们对白人男性的小型回顾性研究，更积极的氯氮平滴定不会增加ADR.未来的研究需要更多不同的样本，应该集中在特定的ADR，快速滴定可能会增加发生率。肥胖患者ADR的风险更高，与指南推荐的这些患者的慢滴定相关。
