ABSTRACT
BACKGROUND: To minimise infection during COVID-19, the clozapine haematological monitoring interval was extended from 4-weekly to 12-weekly intervals in South London and Maudsley NHS Foundation Trust. AIMS: To investigate the impact of this temporary policy change on clinical and safety outcomes. METHOD: All patients who received clozapine treatment with extended (12-weekly) monitoring in a large London National Health Service trust were included in a 1-year mirror-image study. A comparison group was selected with standard monitoring. The proportion of participants with mild to severe neutropenia and the proportion of participants attending the emergency department for clozapine-induced severe neutropenia treatment during the follow-up period were compared. Psychiatric hospital admission rates, clozapine dose and concomitant psychotropic medication in the 1 year before and the 1 year after extended monitoring were compared. All-cause clozapine discontinuation at 1-year follow-up was examined. RESULTS: Of 569 participants, 459 received clozapine with extended monitoring and 110 controls continued as normal. The total person-years were 458 in the intervention group and 109 in the control group, with a median follow-up time of 1 year in both groups. During follow-up, two participants (0.4%) recorded mild to moderate neutropenia in the intervention group and one (0.9%) in the control group. There was no difference in the incidence of haematological events between the two groups (IRR = 0.48, 95% CI 0.02-28.15, P = 0.29). All neutropenia cases in the intervention group were mild, co-occurring during COVID-19 infection. The median number of admissions per patient during the pre-mirror period remained unchanged (0, IQR = 0) during the post-mirror period. There was one death in the control group, secondary to COVID-19 infection. CONCLUSIONS: There was no evidence that the incidence of severe neutropenia was increased in those receiving extended monitoring.
Subject(s)
Antipsychotic Agents , COVID-19 , Clozapine , Neutropenia , Humans , Clozapine/adverse effects , Antipsychotic Agents/adverse effects , Cohort Studies , State Medicine , Neutropenia/chemically induced , Neutropenia/epidemiology , Neutropenia/drug therapyABSTRACT
OBJECTIVE: The objective of the study is to explore the long-term effectiveness and tolerability of metoclopramide in the treatment of CIH. METHOD: This study is a retrospective, observational cohort study of patients prescribed metoclopramide for CIH at the South London & Maudsley (SLaM) NHS Foundation Trust. RESULTS: Of the 96 patients identified, 14 patients were eligible for inclusion in our study. Five patients continued treatment with a mean duration of 27 months (SD = 17.8), and one patient continued until transfer with a duration of 3 months. Eight patients discontinued treatment after a mean duration of 8 months. CONCLUSION: Metoclopramide may be an effective and tolerated drug in CIH, but more data is required to establish its place in the pharmacotherapy of this condition.
Subject(s)
Antipsychotic Agents , Clozapine , Schizophrenia , Sialorrhea , Antipsychotic Agents/adverse effects , Clozapine/adverse effects , Humans , Metoclopramide/adverse effects , Retrospective Studies , Schizophrenia/drug therapy , Sialorrhea/chemically induced , Sialorrhea/drug therapyABSTRACT
Highlights from the Science family of journals.
ABSTRACT
Highlights from the Science family of journals.
ABSTRACT
Highlights from the Science family of journals.
ABSTRACT
Highlights from the Science family of journals.
ABSTRACT
Highlights from the Science family of journals.
ABSTRACT
Highlights from the Science family of journals.
ABSTRACT
Highlights from the Science family of journals.
ABSTRACT
Highlights from the Science family of journals.
ABSTRACT
Highlights from the Science family of journals.
ABSTRACT
Highlights from the Science family of journals.
ABSTRACT
Highlights from the Science family of journals.
ABSTRACT
Highlights from the Science family of journals.
ABSTRACT
Highlights from the Science family of journals.
ABSTRACT
Highlights from the Science family of journals.
ABSTRACT
Highlights from the Science family of journals.
ABSTRACT
Highlights from the Science family of journals.
ABSTRACT
Highlights from the Science family of journals.
ABSTRACT
Highlights from the Science family of journals.