dc.contributor |
Háskóli Íslands |
dc.contributor |
University of Iceland |
dc.contributor.author |
Ingimarsson, Oddur |
dc.contributor.author |
MacCabe, James |
dc.contributor.author |
Haraldsson, Magnús |
dc.contributor.author |
Jónsdóttir, Halldóra |
dc.contributor.author |
Sigurdsson, Engilbert |
dc.date.accessioned |
2017-09-06T14:37:23Z |
dc.date.available |
2017-09-06T14:37:23Z |
dc.date.issued |
2016-12 |
dc.identifier.citation |
Ingimarsson, O., MacCabe, J. H., Haraldsson, M., Jónsdóttir, H., & Sigurdsson, E. (2016). Neutropenia and agranulocytosis during treatment of schizophrenia with clozapine versus other antipsychotics: an observational study in Iceland. BMC Psychiatry, 16(1), 441. doi:10.1186/s12888-016-1167-0 |
dc.identifier.issn |
1471-244X |
dc.identifier.uri |
https://hdl.handle.net/20.500.11815/381 |
dc.description.abstract |
Background
Data on the haematological outcomes of patients who continue clozapine treatment following neutropenia are very rare as even mild neutropenia results in mandatory discontinuation of clozapine in most countries. However, in Iceland where clozapine monitoring is less stringent allows an observational study to be done on the risk of agranulocytosis and neutropenia during treatment with clozapine compared with other antipsychotics among patients with schizophrenia.
Methods
The present study is a part of a wider ongoing longitudinal study of schizophrenia in Iceland. We identified 201 patients with schizophrenia treated with clozapine and 410 patients with schizophrenia who had never been on clozapine by searching the electronic health records of Landspitali, the National University Hospital. Neutrophil counts were searched in electronic databases to identify patients who developed neutropenia/agranulocytosis and the frequency of neutrophil measurements was examined as well.
Results
The median number of days between neutrophil measurements during the first 18 weeks of clozapine treatment was 25 days but after the first 18 weeks on the drug the median became 124 days. Thirty four cases of neutropenia were identified during clozapine treatment with an average follow up time of 9.2 years. The majority, 24 individuals developed mild neutropenia (1500–1900 neutrophils/mm3). None of these progressed to agranulocytosis. The remaining 10 patients developed neutropenia in the range 500–1400 /mm3 of whom one developed agranulocytosis, three stopped clozapine use and 6 patients continued on clozapine for at least a year without developing agranulocytosis. Unexpectedly, schizophrenia patients on other antipsychotics had an equal risk of developing neutropenia as those on clozapine.
Conclusions
Neutropenia is common both in patients with schizophrenia on clozapine treatment and in those never on clozapine. Therefore a large part of neutropenia during clozapine treatment is probably not caused by clozapine. These findings have implications in assessing the balance between the risk of progression from neutropenia to agranulocytosis against the morbidity resulting from the premature discontinuation of clozapine under the current monitoring regulations in the US and in most of Europe. |
dc.description.sponsorship |
This project received funding from the European Union's Seventh Framework Programme for research, technological development and demonstration under grant agreement no. 279227 (Crestar). Dr MacCabe receives salary support from the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. Our funders had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. The views expressed are those of the authors and not necessarily those of the European Union, the NHS, the NIHR or the UK Department of Health. |
dc.format.extent |
441 |
dc.language.iso |
en |
dc.publisher |
Springer Nature |
dc.relation |
info:eu-repo/grantAgreement/EC/FP7/279227 |
dc.relation.ispartofseries |
BMC Psychiatry;16(1) |
dc.rights |
info:eu-repo/semantics/openAccess |
dc.subject |
Schizophrenia |
dc.subject |
Clozapine |
dc.subject |
Antipsychotics |
dc.subject |
Neutropenia |
dc.subject |
Agranulocytosis |
dc.subject |
Geðklofi |
dc.subject |
Geðlyf |
dc.subject |
Blóðsjúkdómar |
dc.title |
Neutropenia and agranulocytosis during treatment of schizophrenia with clozapine versus other antipsychotics: an observational study in Iceland |
dc.type |
info:eu-repo/semantics/article |
dcterms.license |
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
dc.description.version |
Peer Reviewed |
dc.identifier.journal |
BMC Psychiatry |
dc.identifier.doi |
10.1186/s12888-016-1167-0 |
dc.contributor.department |
Læknadeild (HÍ) |
dc.contributor.department |
Faculty of Medicine (UI) |
dc.contributor.school |
Heilbrigðisvísindasvið (HÍ) |
dc.contributor.school |
School of Health Sciences (UI) |