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Barriers to using clozapine in treatment-resistant schizophrenia: systematic review

  • Saeed Farooq (a1), Abid Choudry (a2), Dan Cohen (a3), Farooq Naeem (a4) and Muhammad Ayub (a4)...
Abstract
Aims and method

To systematically review the literature on barriers to the use of clozapine and identify any interventions for optimizing clozapine use in treatment-resistant schizophrenia. Journal databases were searched from 1972 to March 2018. The following search terms were used: treatment-resistant schizophrenia, clozapine, barriers, use, prescription rates, implementation, clozaril and prescribing practices. Following a review of the literature, 15 papers were included in the review.

Results

The major barriers that were identified included mandatory blood testing, fear of serious side-effects and lack of adherence by the patients, difficulty in identifying suitable patients, service fragmentation, and inadequate training in or exposure to using clozapine.

Clinical implications

In view of consistent evidence across the studies on inadequate knowledge and skills as a significant barrier, we suggest that a certification requiring competence in initiating and managing side-effects of clozapine becomes a mandatory requirement in training programmes.

Declarations of interest

None.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Correspondence to Saeed Farooq (Sfarooqlrh@yahoo.com)
References
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1Farooq, S, Taylor, M. Clozapine. Br J Psychiatry 2011; 198(4): 247–9.
2Leucht, S, Corves, C, Arbter, D, Engel, RR, Li, C, Davis, JM. Second-generation versus first-generation antipsychotic drugs for schizophrenia: a metaanalysis. Lancet 2009; 373: 3141.
3McEvoy, JP, Lieberman, JA, Stroup, TS, Davis, SM, Meltzer, HY, Rosenheck, RA, et al. Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. Am J Psychiatry 2006; 163: 600–10.
4Lewis, SW, Barnes, TRE, Davies, L, Murray, RM, Dunn, G, Hayhurst, KP, et al. Randomized controlled trial of effect of prescription of clozapine versus other second-generation antipsychotic drugs in resistant schizophrenia. Schizophr Bull 2006; 32: 715–23.
5Krakowski, MI, Czobor, P, Citrome, L, Bark, N, Cooper, TB. Atypical antipsychotic agents in the treatment of violent patients with schizophrenia and schizoaffective disorder. Arch Gen Psychiatry 2006; 63: 622–9.
6Brunette, MF, Drake, RE, Xie, H, McHugo, GJ, Green, AI. Clozapine use and relapses of substance use disorder among patients with co-occurring schizophrenia and substance use disorders. Schizophr Bull 2006; 32: 637.
7Tiihonen, J, Lönnqvist, J, Wahlbeck, K, Klaukka, T, Niskanen, L, Tanskanen, A, et al. 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet 2009; 374: 620–7.
8Warnez, S, Alessi-Severini, S. Clozapine: a review of clinical practice guidelines and prescribing trends. BMC Psychiatry 2014; 14: 102.
9Downs, J, Zinkler, M. Clozapine: national review of postcode prescribing. Psychiatr Bull 2007; 31: 384–7.
10Howes, O, Vergunst, F, Gee, S, McGuire, P, Kapur, S, Taylor, D. Adherence to treatment guidelines in clinical practice: study of antipsychotic treatment prior to clozapine initiation. Br J Psychiatry 2012; 201(6): 481–5.
11Wheeler, AJ. Treatment pathway and patterns of clozapine prescribing for schizophrenia in New Zealand. Ann Pharmacother 2008; 42(6): 852–60.
12Torrey, EF, Knable, MB, Quanbeck, C, et al. Clozapine for Treating Schizophrenia: A Comparison of the States. Treatment Advocacy Center, 2015 (http://www.treatmentadvocacycenter.org/storage/documents/clozapine-for-treating-schizophrenia.pdf).
13Nielsen, J, Dahm, M, Lublin, H, Taylor, D. Psychiatrists’ attitude towards and knowledge of clozapine treatment. J Psychopharmacol 2009; 24(7): 965–71.
14Moher, D, Liberati, A, Tetzlaff, J, Altman, DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151(4): 264–9.
15Farooq, S, Choudry, A, Cohen, D, Naeem, F, Ayub, M. Barriers to optimum use of clozapine in Treatment Resistant Schziophrenia (TRS): a systematic review. PROSPERO 2017; CRD42017059434 (available from http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017059434).
16Taylor, DM, Young, C, Paton, C. Prior antipsychotic prescribing in patients currently receiving clozapine: a case note review. J Clin Psychiatry 2003; 64: 30–4.
17Gee, S, Vergunst, F, Howes, O, Taylor, D. Practitioner attitudes to clozapine initiation. Acta Psychiatr Scand 2014; 130(1): 1624.
18Kelly, DL, Ben-Yoav, H, Payne, GF, Winkler, TE, Chocron, SE, Kim, E, et al. Blood draw barriers for treatment with clozapine and development of point-of-care monitoring device. Clin Schizophr Relat Psychoses Spring 2018; 12(1): 2330.
19Swinton, M, Ahmed, AG. Reasons for non-prescription of clozapine in treatment-resistant schizophrenia. Crim Behav Ment Health 1999; 9(3): 207–14.
20Najim, H, Heath, D, Singh, P. Antipsychotic prescribing before clozapine in a community psychiatric hospital: a case note review. Psychiatr Danub 2013; 25(Suppl 2): S16570.
21Grover, S, Hazari, N, Chakrabarti, S, Avasthi, A. Delay in initiation of clozapine: a retrospective study from a tertiary care hospital in North India. Psychiatry Res 2015; 226(1): 181–5.
22Tungaraza, TE, Farooq, S. Clozapine prescribing in the UK: views and experience of consultant psychiatrists. Ther Adv Psychopharmacol 2015; 5(2): 8896.
23Apiquian, R, Fresán, A, De la Fuente-Sandoval, C, Ulloa, RE, Nicolini, H. Survey on schizophrenia treatment in Mexico: perception and antipsychotic prescription patterns. BMC Psychiatry 2004; 4(1): 12.
24Cirulli, G. Clozapine prescribing in adolescent psychiatry: survey of prescribing practice in in-patient units. The Psychiatrist 2005; 29(10): 377–80.
25Stroup, TS, Gerhard, T, Crystal, S, Huang, C, Olfson, M. Geographic and clinical variation in clozapine use in the United States. Psychiatr Serv 2014; 65(2): 186–92.
26Gören, JL, Rose, AJ, Engle, RL, Smith, EG, Christopher, ML, Rickles, NM, et al. Organizational characteristics of Veterans Affairs clinics with high and low utilization of clozapine. Psychiatr Serv 2016; 67(11): 1189–96.
27Kelly, DL, et al. Addressing barriers to clozapine underutilization: a national effort. Psychiatr Serv 2018; 69: 224–7.
28Carruthers, J, Radigan, M, Erlich, MD, Gu, G, Wang, R, Frimpong, EY, et al. An initiative to improve clozapine prescribing in New York State. Psychiatr Serv 2015; 67(4): 369–71.
29Bogers, JP, Bui, H, Herruer, M, Cohen, D. Capillary compared to venous blood sampling in clozapine treatment: patients׳ and healthcare practitioners׳ experiences with a point-of-care device. Eur Neuropsychopharmacol 2015; 25(3): 319–24.
30Nielsen, J, Thode, D, Stenager, E, Andersen, , Sondrup, U, Hansen, TN, et al. Hematological clozapine monitoring with a point-of-care device: a randomized cross-over trial. Eur Neuropsychopharmacol 2012; 22(6): 401–5.
31Kennedy, JL, Altar, CA, Taylor, DL, Degtiar, I, Hornberger, JC. The social and economic burden of treatment-resistant schizophrenia: a systematic literature review. Int Clin Psychopharmacol 2014; 29(2): 6376.
32NICE Guidance Quality Standard 80. Psychosis and Schizophrenia in Adults. 2015. (https://www.nice.org.uk/guidance/qs80).
33Love, RC, Kelly, DL, Freudenreich, O, et al. Clozapine Underutilization: Addressing the Barriers. National Association of State Mental Health Program Directors, 2016 (http://nasmhpd.org/sites/default/files/Assessment%201_Clozapine%20Underutilization.pdf).
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Barriers to using clozapine in treatment-resistant schizophrenia: systematic review

  • Saeed Farooq (a1), Abid Choudry (a2), Dan Cohen (a3), Farooq Naeem (a4) and Muhammad Ayub (a4)...
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