Clinical and laboratory characteristics of clozapine-treated patients with schizophrenia referred to a national immunodeficiency clinic reveals a B-cell signature resembling common variable immunodeficiency (CVID)
| Autor: | Mathew Burgess, Stephen Jolles, Colin Price, Rachael Steven, Emily Carne, Kathyrn Bramhall, Frances McGuire, Sonali Wijetilleka, Mo Moody, Soha Zouwail, Daniel Farewell, Mark J. Ponsford, Tariq El-Shanawany, Tayyeb A. Tahir |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Population Schizoaffective disorder Pathology and Forensic Medicine 03 medical and health sciences 0302 clinical medicine Internal medicine diagnostics medicine antibodies Humans Antipsychotic education Clozapine Immunodeficiency Original Research Retrospective Studies B-Lymphocytes education.field_of_study business.industry flow cytometry Common variable immunodeficiency Immunologic Deficiency Syndromes General Medicine medicine.disease psychiatry 030227 psychiatry Common Variable Immunodeficiency Schizophrenia Primary immunodeficiency business immunodeficiency 030217 neurology & neurosurgery Antipsychotic Agents medicine.drug |
| Zdroj: | Journal of Clinical Pathology |
| ISSN: | 1472-4146 0021-9746 |
| DOI: | 10.1136/jclinpath-2019-206235 |
| Popis: | AimsAn association between antibody deficiency and clozapine use in individuals with schizophrenia has recently been reported. We hypothesised that if clozapine-associated hypogammaglobulinaemia was clinically relevant this would manifest in referral patterns.MethodsRetrospective case note review of patients referred and assessed by Immunology Centre for Wales (ICW) between January 2005 and July 2018 with extraction of clinical and immunological features for individuals with diagnosis of schizophrenia-like illness.Results1791 adult patients were assessed at ICW during this period; 23 patients had a psychiatric diagnosis of schizophrenia or schizoaffective disorder. Principal indications for referral were findings of low calculated globulin and immunoglobulins. Clozapine was the single most commonly prescribed antipsychotic (17/23), disproportionately increased relative to reported use in the general schizophrenia population (OR 6.48, 95% CI: 1.79 to 23.5). Clozapine therapy was noted in 6/7 (86%) of patients subsequently requiring immunoglobulin replacement therapy (IgRT). Marked reduction of class-switched memory B cells (CSMB) and plasmablasts were observed in clozapine-treated individuals relative to healthy age-matched controls. Clozapine duration is associated with CSMB decline. One patient discontinued clozapine, with gradual recovery of IgG levels without use of IgRT.ConclusionsOur findings are consistent with enrichment of clozapine-treatment within schizophrenic individuals referred for ICW assessment over the last 13 years. These individuals displayed clinical patterns closely resembling the primary immunodeficiency common variable immunodeficiency, however appears reversible on drug cessation. This has diagnostic, monitoring and treatment implications for psychiatry and immunology teams and directs prospective studies to address causality and the wider implications for this patient group. |
| Databáze: | OpenAIRE |
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