Clozapine rechallenge following neutropenia using granulocyte colony-stimulating factor: A Quebec case series.
J Psychopharmacol
; 35(9): 1152-1157, 2021 Sep.
Article
in En
| MEDLINE
| ID: mdl-34229529
ABSTRACT
BACKGROUND:
Clozapine has a unique efficacy profile among individuals suffering from treatment-resistant schizophrenia, but is associated with hematological side effects. The use of granulocyte colony-stimulating factors (G-CSF) to allow clozapine continuation or rechallenge has emerged as a promising option, but evidence is still scarce.AIM:
To describe the largest case series so far published regarding this practice.METHOD:
A national clozapine hematological monitoring database was consulted to identify all patients who had had neutrophil count <1.5 × 109/L since 2004 in Quebec and was cross-referenced with hospital pharmacy software to identify patients who had received at least one dose of G-CSF, such as filgrastim, while being exposed to clozapine. All data were collected retrospectively, using patients' medical files, from January to July 2019.RESULTS:
Using G-CSF, three out of eight patients could maintain clozapine despite neutropenia episodes that otherwise would have required treatment discontinuation. The only side effect reported was mild short-lived back pain, over a mean 3-year follow-up period. In all but one case, filgrastim was used on an "as-needed" basis at doses of 300 mcg administered subcutaneously.CONCLUSION:
These results suggest that the "as-needed" use of G-CSF is well-tolerated and may allow clozapine rechallenge in some well-selected patients, adding to the paucity of data regarding long-term safety and efficacy of this strategy. More research may help to better define potential candidates and optimal regimen of such practice.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Granulocyte Colony-Stimulating Factor
/
Clozapine
/
Schizophrenia, Treatment-Resistant
/
Neutropenia
Type of study:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
America do norte
Language:
En
Journal:
J Psychopharmacol
Journal subject:
PSICOFARMACOLOGIA
Year:
2021
Document type:
Article
Affiliation country:
Canada