Clozapine, neutropenia and Covid-19: should clinicians be concerned? 3 months report
Background: Clozapine is among the most effective antipsychotics used for treatment resistant schizophrenia. Adverse reactions to clozapine include neutropenia. In March 2020, at the start of the Coronavirus −19 pandemic, clinicians raised concerns regarding continuation of antipsychotic treatment,...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-05-01
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| Series: | Brain, Behavior, & Immunity - Health |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666354621000156 |
| _version_ | 1818899876870619136 |
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| author | Stefania Bonaccorso Angelo Ricciardi Sophie Ouabbou Christos Theleritis Arabella Ross-Michaelides Antonio Metastasio Neil Stewart Marwa Mohammed Fabrizio Schifano |
| author_facet | Stefania Bonaccorso Angelo Ricciardi Sophie Ouabbou Christos Theleritis Arabella Ross-Michaelides Antonio Metastasio Neil Stewart Marwa Mohammed Fabrizio Schifano |
| author_sort | Stefania Bonaccorso |
| collection | DOAJ |
| description | Background: Clozapine is among the most effective antipsychotics used for treatment resistant schizophrenia. Adverse reactions to clozapine include neutropenia. In March 2020, at the start of the Coronavirus −19 pandemic, clinicians raised concerns regarding continuation of antipsychotic treatment, and specifically of clozapine, in patients with coronavirus disease. We aimed here at providing a short report focusing on the association between neutropenia and clozapine in a case series of psychiatric inpatients diagnosed with COVID-19. Patients & methods: We retrospectively inspected data of 10 patients on clozapine, admitted to Highgate Mental Health Centre, Camden & Islington NHS Foundation Trust, between March and July 2020; selection was based on their COVID-19 positive PCR test. We used a linear regression model to estimate whether there was a significant drop in the neutrophil count during SARS-CoV-2 infection.The analysis was done in R using a linear regression to the origin. Results: Data were collected on 10 patients, of which 7 were males. During COVID-19 infection, neutrophils’ count (ANC) was 4.13 × 109/l (SD = 2.70) which constituted a significant drop from a baseline value of 5.2 × 109/l (SD = 2.24). The mean relative reduction in ANC was −0.2729 (SD = 0.1666). The beta value of 0.8377 obtained with the linear regression showed that ANC values during SARS-CoV-2 infection were 83.77% of the baseline ANC showing that within the two time points there was a decrease of 16.23%. The linear regression had a pvalue = 8.96 × 10–8 and an adjusted R2 of 95.94% which shows that the variability of the data is very well explained by the model. We also compared baseline ANC with ANC values approximately a month after resolution of the infection and results indicate that ANC values return to a 95% of baseline. Conclusions: Clinicians should bear in mind that a significant drop in neutrophils’ count may occur in patients taking clozapine and affected from a SARS-CoV-2 infectionand that this drop is only transitory. |
| first_indexed | 2024-12-19T19:54:56Z |
| format | Article |
| id | doaj.art-21213bba4d9643d296973856d026e962 |
| institution | Directory Open Access Journal |
| issn | 2666-3546 |
| language | English |
| last_indexed | 2024-12-19T19:54:56Z |
| publishDate | 2021-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain, Behavior, & Immunity - Health |
| spelling | doaj.art-21213bba4d9643d296973856d026e9622022-12-21T20:07:51ZengElsevierBrain, Behavior, & Immunity - Health2666-35462021-05-0113100212Clozapine, neutropenia and Covid-19: should clinicians be concerned? 3 months reportStefania Bonaccorso0Angelo Ricciardi1Sophie Ouabbou2Christos Theleritis3Arabella Ross-Michaelides4Antonio Metastasio5Neil Stewart6Marwa Mohammed7Fabrizio Schifano8Highgate Mental Health Centre, Camden & Islington NHS Foundation Trust, Dartmouth Park Hill, N19 5 NX, UK; University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK; King’s College London, Denmark Hill, Brixton, London, SE5 9RS, UK; University of Hertfordshire, De Havilland Campus, Mosquito Way, Hatfield, AL10 9EU, UK; Corresponding author. Highgate Mental Health Centre, Camden & Islington NHS Foundation Trust, Dartmouth Park Hill, N19 5 NX, UK.DSM ASL Roma 1, CSM Via Monte Tomatico, 9, 00141, Rome, Italy; Highgate Mental Health Centre, Camden & Islington NHS Foundation Trust, Dartmouth Park Hill, N19 5 NX, UKHighgate Mental Health Centre, Camden & Islington NHS Foundation Trust, Dartmouth Park Hill, N19 5 NX, UK1st Psychiatry Dept, National and Kapodistrian University of Athens, GreeceHighgate Mental Health Centre, Camden & Islington NHS Foundation Trust, Dartmouth Park Hill, N19 5 NX, UKHighgate Mental Health Centre, Camden & Islington NHS Foundation Trust, Dartmouth Park Hill, N19 5 NX, UKHighgate Mental Health Centre, Camden & Islington NHS Foundation Trust, Dartmouth Park Hill, N19 5 NX, UKHighgate Mental Health Centre, Camden & Islington NHS Foundation Trust, Dartmouth Park Hill, N19 5 NX, UKUniversity of Hertfordshire, De Havilland Campus, Mosquito Way, Hatfield, AL10 9EU, UKBackground: Clozapine is among the most effective antipsychotics used for treatment resistant schizophrenia. Adverse reactions to clozapine include neutropenia. In March 2020, at the start of the Coronavirus −19 pandemic, clinicians raised concerns regarding continuation of antipsychotic treatment, and specifically of clozapine, in patients with coronavirus disease. We aimed here at providing a short report focusing on the association between neutropenia and clozapine in a case series of psychiatric inpatients diagnosed with COVID-19. Patients & methods: We retrospectively inspected data of 10 patients on clozapine, admitted to Highgate Mental Health Centre, Camden & Islington NHS Foundation Trust, between March and July 2020; selection was based on their COVID-19 positive PCR test. We used a linear regression model to estimate whether there was a significant drop in the neutrophil count during SARS-CoV-2 infection.The analysis was done in R using a linear regression to the origin. Results: Data were collected on 10 patients, of which 7 were males. During COVID-19 infection, neutrophils’ count (ANC) was 4.13 × 109/l (SD = 2.70) which constituted a significant drop from a baseline value of 5.2 × 109/l (SD = 2.24). The mean relative reduction in ANC was −0.2729 (SD = 0.1666). The beta value of 0.8377 obtained with the linear regression showed that ANC values during SARS-CoV-2 infection were 83.77% of the baseline ANC showing that within the two time points there was a decrease of 16.23%. The linear regression had a pvalue = 8.96 × 10–8 and an adjusted R2 of 95.94% which shows that the variability of the data is very well explained by the model. We also compared baseline ANC with ANC values approximately a month after resolution of the infection and results indicate that ANC values return to a 95% of baseline. Conclusions: Clinicians should bear in mind that a significant drop in neutrophils’ count may occur in patients taking clozapine and affected from a SARS-CoV-2 infectionand that this drop is only transitory.http://www.sciencedirect.com/science/article/pii/S2666354621000156ClozapineCoronavirusCOVID-19SARS-CoV-2PsychosisSchizophrenia |
| spellingShingle | Stefania Bonaccorso Angelo Ricciardi Sophie Ouabbou Christos Theleritis Arabella Ross-Michaelides Antonio Metastasio Neil Stewart Marwa Mohammed Fabrizio Schifano Clozapine, neutropenia and Covid-19: should clinicians be concerned? 3 months report Brain, Behavior, & Immunity - Health Clozapine Coronavirus COVID-19 SARS-CoV-2 Psychosis Schizophrenia |
| title | Clozapine, neutropenia and Covid-19: should clinicians be concerned? 3 months report |
| title_full | Clozapine, neutropenia and Covid-19: should clinicians be concerned? 3 months report |
| title_fullStr | Clozapine, neutropenia and Covid-19: should clinicians be concerned? 3 months report |
| title_full_unstemmed | Clozapine, neutropenia and Covid-19: should clinicians be concerned? 3 months report |
| title_short | Clozapine, neutropenia and Covid-19: should clinicians be concerned? 3 months report |
| title_sort | clozapine neutropenia and covid 19 should clinicians be concerned 3 months report |
| topic | Clozapine Coronavirus COVID-19 SARS-CoV-2 Psychosis Schizophrenia |
| url | http://www.sciencedirect.com/science/article/pii/S2666354621000156 |
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