Risk of neutropenia among clozapine users and non-users: results from 5,847 patients
Braz. J. Psychiatry (São Paulo, 1999, Impr.)
; 44(1): 21-25, Jan.-Feb. 2022. tab, graf
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| ID: biblio-1360182
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ABSTRACT
Objective:
Clozapine is underprescribed due to neutropenia risk. Blood tests every 3 months in those on continuous treatment for > 1 year who have never had an absolute neutrophil count (ANC) < 2,000/µL has been proposed as a monitoring strategy; however, there are no South American data to support this recommendation. This study sought to investigate whether clozapine use and other variables could explain the occurrence of ANC < 1,000/µL in patients with severe mental disorders.Methods:
A total of 5,847 subjects were included, 1,038 on clozapine. We performed a Cox regression considering the outcome as ANC < 1,000/µL at any time point. Predictors were sex, age, ethnicity, clozapine use, ANC > 2,000/µL during the first year of blood monitoring, and presence of a severe medical condition.Results:
In the Cox regression model, ethnicity (white) (hazard ratio [HR] 0.53; 95%CI 0.29-0.99, p < 0.05) and ANC > 2,000/µL (HR 0.04; 95%CI 0.01-0.10, p < 0.001) were protective factors, while presence of a severe medical condition (HR 69.35; 95%CI 37.45-128.44, p < 0.001) was a risk factor for ANC < 1,000/µL. Other variables were not significant, including clozapine use (HR 1.33; 95%CI 0.74-2.39, p > 0.05).Conclusions:
These findings suggest that clozapine does not increase the risk of neutropenia in subjects with ANC > 2,000/µL during the first year of use and in the absence of a severe medical condition. These results could help guide clinical and public-health decisions regarding clozapine blood monitoring guidelines.
Texte intégral:
1
Indice:
LILACS
Type d'étude:
Etiology_studies
/
Guideline
/
Prognostic_studies
/
Risk_factors_studies
langue:
En
Texte intégral:
Braz. J. Psychiatry (São Paulo, 1999, Impr.)
Thème du journal:
PSIQUIATRIA
Année:
2022
Type:
Article