Krivoy, Amir, Whiskey, Eromona, Webb-Wilson, Henrietta, Joyce, Dan, Tracy, Derek K., Gaughran, Fiona, MacCabe, James H., Shergill, Sukhwinder S. (2021) Outcomes in treatment-resistant schizophrenia: symptoms, function and clozapine plasma concentrations. Therapeutic Advances in Psychopharmacology, 11 . pp. 1-9. ISSN 2045-1253. (doi:10.1177/20451253211037179) (KAR id:97159)
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Official URL: https://doi.org/10.1177/20451253211037179 |
Abstract
Background: Clozapine is the only medication licenced for treating patients with treatment-refractory schizophrenia. However, there are no evidence-based guidelines as to the optimal plasma level of clozapine to aim for, and their association with clinical and functional outcome.
Objective: We assessed the relationship between clinical and functional outcome measures and blood concentrations of clozapine among patients with treatment-refractory psychosis.
Methods: Data were reviewed in 82 patients with treatment-refractory psychosis admitted to a specialised tertiary-level service and treated with clozapine. Analysis focussed on the relationship between clozapine and norclozapine plasma concentrations and the patient’s clinical symptoms and functional status.
Results: Clinical symptom improvement was positively correlated with norclozapine plasma concentrations and inversely correlated with clozapine to norclozapine plasma concentrations ratio. Clozapine concentrations showed a bimodal association with clinical improvement (peaks around 350 and 660 ng/ml). Clinical symptom improvement correlated with functional outcomes, although there was no significant correlation between the latter and clozapine or norclozapine plasma concentrations.
Conclusion: Clozapine treatment was associated with optimal clinical improvement at two different peak plasma concentrations around 350 and 650 ng/ml. Clinical improvement was associated with functional outcome; however, functionality was not directly associated with clozapine concentrations. A subset of patients may require higher clozapine plasma concentrations to achieve clinical improvement.
Item Type: | Article |
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DOI/Identification number: | 10.1177/20451253211037179 |
Uncontrolled keywords: | psychosis, clozapine, norclozapine |
Subjects: | R Medicine |
Divisions: | Divisions > Division of Natural Sciences > Kent and Medway Medical School |
Depositing User: | Rachael Heller |
Date Deposited: | 28 Sep 2022 08:33 UTC |
Last Modified: | 05 Nov 2024 13:02 UTC |
Resource URI: | https://kar.kent.ac.uk/id/eprint/97159 (The current URI for this page, for reference purposes) |
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