Clozapine levels and outcomes in Serbian patients with treatment-resistant psychotic disorders previously treated without measuring clozapine levels (CLOSER).

Autor: de Haas HJ; Arkin Mental Health Care, Klaprozenweg 111, Amsterdam 1033 NN, the Netherlands; Department of Psychiatry, Amsterdam UMC (location AMC), Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands. Electronic address: hans.de.haas@arkin.nl., Cohen D; Mental Health Services Noord-Holland-Noord, Oude Hoeverweg 10, Alkmaar 1816 BT, the Netherlands., de Koning MB; Arkin Mental Health Care, Klaprozenweg 111, Amsterdam 1033 NN, the Netherlands; Department of Psychiatry, Amsterdam UMC (location AMC), Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands., van Weringh G; Department of Clinical Pharmacy, OLVG Hospital, Jan Tooropstraat 164, Amsterdam 1061 AE, the Netherlands; University of Groningen, Groningen Research Institute of Pharmacy, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands., Petrovic V; Special Hospital for Psychiatric Disorders Kovin, Cara Lazara 253, Kovin 26220, Serbia., de Haan L; Arkin Mental Health Care, Klaprozenweg 111, Amsterdam 1033 NN, the Netherlands; Department of Psychiatry, Amsterdam UMC (location AMC), Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands., Touw DJ; University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Hanzeplein 1, Groningen 9713 GZ, the Netherlands., Ignjatovic Ristic D; University of Kragujevac, Faculty of Medical Sciences, Department of Psychiatry, Liceja Knezevine Srbije 1A, Kragujevac 34000, Serbia.
Jazyk: angličtina
Zdroj: Psychiatry research [Psychiatry Res] 2024 Sep; Vol. 339, pp. 116070. Date of Electronic Publication: 2024 Jun 28.
DOI: 10.1016/j.psychres.2024.116070
Abstrakt: Clozapine remains the only pharmacological treatment option for treatment-resistant schizophrenia. Therapeutic drug monitoring (TDM) of clozapine is recommended, although evidence for the therapeutic range of 350-600 ng/ml is limited. In various countries including Serbia, TDM of clozapine is not routinely performed. This study evaluated the distribution of clozapine levels and their relationship with clinical outcomes in Serbian patients who had not undergone prior TDM. 140 Patients with treatment-resistant schizophrenia and schizo-affective disorder were enrolled. Clozapine levels were measured by dried blood spot (DBS) analysis. Side effects were evaluated by GASS-c, severity of symptoms and functional impairment with WHODAS, CGI-S and GAF. Of the patients, 51.2% had subtherapeutic levels, 24.8% were in the therapeutic window, and 24% had supratherapeutic levels. Clozapine levels showed no association with side effects and a weak positive association with symptom severity and functional impairment. No serious side effects were observed in patients with clozapine levels surpassing 1000 ng/ml (n = 8). Based on these findings, we propose that the upper limit of the therapeutic range should not be regarded as an absolute barrier, and guidelines should allow for a personalized approach when prescribing clozapine.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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