Severe neutropenia unrelated to clozapine in patients receiving clozapine.

Autor:	Taylor D; Institute of Pharmaceutical Science, King's College London, London, UK.; Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK., Vallianatou K; Institute of Pharmaceutical Science, King's College London, London, UK.; Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK., Gandhi S; Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK., Casetta C; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.; National Psychosis Unit, South London and Maudsley NHS Foundation Trust, Beckenham, Kent, UK., Howes O; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.; Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, London, UK., MacCabe J; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.; National Psychosis Unit, South London and Maudsley NHS Foundation Trust, Beckenham, Kent, UK.
Jazyk:	angličtina
Zdroj:	Journal of psychopharmacology (Oxford, England) [J Psychopharmacol] 2024 Jul; Vol. 38 (7), pp. 624-635. Date of Electronic Publication: 2024 Jul 23.
DOI:	10.1177/02698811241262767
Abstrakt:	Background: Clozapine is known to cause agranulocytosis. Mandatory monitoring schemes are aimed at reducing the risk of agranulocytosis and of the consequences of agranulocytosis. All cases of agranulocytosis occurring in people prescribed clozapine are assumed to be caused by clozapine. Methods: In a previous study, we examined a cohort of patients listed on our hospital database as having had clozapine-induced agranulocytosis and applied specific criteria to identify those with confirmed clozapine-related, life-threatening agranulocytosis. In this study, we examine the cases not meeting these specific criteria. Results: In the original study, 9 of 23 cases met the criteria for clozapine-induced, life-threatening agranulocytosis. Of the 13 remaining cases for whom data were available, 5 were probably caused by clozapine but were not life-threatening. Three cases were the result of concomitant cancer chemotherapy. Three were anomalous results probably related to measurement error. For the remaining two cases, the cause was not identified. Conclusion: Not all cases of agranulocytosis occurring in people taking clozapine are caused by clozapine. The widely used threshold criterion-based diagnosis overestimates the risk of agranulocytosis. True clozapine-related agranulocytosis is best identified by pattern-based criteria: rapid fall in neutrophil counts over around 2 weeks to below 0.5 × 109/L for two consecutive days (unless clozapine is stopped very early or granulocyte colony stimulating factor is given) where other possible causes (benign ethnic neutropenia, cancer chemotherapy) can be ruled out. Competing Interests: Declaration of conflicting interestsThe author(s) disclosed potential conflicts of interest with respect to the research, authorship, and/or publication of this article: DT reports research funding from Janssen and speaker’s honoraria from Janssen, Otsuka, Viatris and Recordati. CC currently receives funding from the National Institute for Health Research (NIHR) NIHR131175. The views expressed are those of the author and not necessarily those of the NIHR. OH has received investigator-initiated research funding from and/or participated in advisory/speaker meetings organised by Angellini, Autifony, Biogen, Boehringer-Ingelheim, Eli Lilly, Elysium, Heptares, Global Medical Education, Invicro, Jansenn, Karuna, Lundbeck, Merck, Neurocrine, Ontrack/Pangea, Otsuka, Sunovion, Recordati, Roche, Rovi and Viatris/Mylan. OH was previously a part-time employee of Lundbeck A/v. OH has a patent for the use of dopaminergic imaging. JHM currently receives funding from the National Institute for Health Research (NIHR) NIHR131157, NIHR150308, NIHR131175, and the Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. The views expressed are those of the author and not necessarily those of the NHS/NIHR or the Department of Health. JHM has received investigator-initiated research funding from H Lundbeck. JHM has received research funding for clinical trials from H Lundbeck and Karuna Therapeutics and has participated in advisory boards for H Lundbeck, LB Pharma, Newron Pharmaceuticals and Teva UK Ltd. KV and SG declare no interest.
Databáze:	MEDLINE
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