Duration of prior psychotic illness and clozapine response: a retrospective observational study using electronic health records
Background: Clozapine is the gold-standard medication for treatment-resistant schizophrenia (TRS) yet its initiation is often delayed. Objective: To examine whether earlier initiation of clozapine in TRS is associated with lower Clinical Global Impression – Severity (CGI-S) scores at 2 years. Method...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2022-06-01
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| Series: | Therapeutic Advances in Psychopharmacology |
| Online Access: | https://doi.org/10.1177/20451253221103353 |
| _version_ | 1829462388901937152 |
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| author | Rowena Jones Rachel Upthegrove Malcolm J. Price Megan Pritchard Joht Singh Chandan Sophie Legge James H. MacCabe |
| author_facet | Rowena Jones Rachel Upthegrove Malcolm J. Price Megan Pritchard Joht Singh Chandan Sophie Legge James H. MacCabe |
| author_sort | Rowena Jones |
| collection | DOAJ |
| description | Background: Clozapine is the gold-standard medication for treatment-resistant schizophrenia (TRS) yet its initiation is often delayed. Objective: To examine whether earlier initiation of clozapine in TRS is associated with lower Clinical Global Impression – Severity (CGI-S) scores at 2 years. Methods: This was a retrospective cohort study from electronic health records of patients with first adequate trial of clozapine at the South London and Maudsley mental health service between 1 January 2007 and 31 December 2016. Dates of illness onset and clozapine commencement were manually extracted from anonymised case notes. CGI-S scores were rated blind to illness duration. Ordinal logistic regression was used to describe the association between illness duration at baseline and CGI-S outcome score at 2 years, following adjustment for CGI-S start score and other key covariates. Results: Among the 401 patients included, there was an association between illness duration and CGI-S outcome score with a 4% increase in the odds of a higher (worse) outcome CGI-S score per year of illness [adjusted odds ratio (AOR) = 1.04; 95% confidence interval (CI): 1.01–1.06]. The association between illness duration and clozapine response was most marked at less than 4 years illness duration. There were too few clozapine initiations within the first 2 years of illness to draw any conclusions about early clozapine initiation. Conclusion: Initiation of clozapine within 2–4 years of psychotic illness onset offers the best outcome for TRS, but the advantage, if any, of earlier initiation is unclear from these data. |
| first_indexed | 2024-12-12T12:09:07Z |
| format | Article |
| id | doaj.art-dbc3319030df4625b74688c938fbc746 |
| institution | Directory Open Access Journal |
| issn | 2045-1261 |
| language | English |
| last_indexed | 2024-12-12T12:09:07Z |
| publishDate | 2022-06-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Psychopharmacology |
| spelling | doaj.art-dbc3319030df4625b74688c938fbc7462022-12-22T00:24:56ZengSAGE PublishingTherapeutic Advances in Psychopharmacology2045-12612022-06-011210.1177/20451253221103353Duration of prior psychotic illness and clozapine response: a retrospective observational study using electronic health recordsRowena JonesRachel UpthegroveMalcolm J. PriceMegan PritchardJoht Singh ChandanSophie LeggeJames H. MacCabeBackground: Clozapine is the gold-standard medication for treatment-resistant schizophrenia (TRS) yet its initiation is often delayed. Objective: To examine whether earlier initiation of clozapine in TRS is associated with lower Clinical Global Impression – Severity (CGI-S) scores at 2 years. Methods: This was a retrospective cohort study from electronic health records of patients with first adequate trial of clozapine at the South London and Maudsley mental health service between 1 January 2007 and 31 December 2016. Dates of illness onset and clozapine commencement were manually extracted from anonymised case notes. CGI-S scores were rated blind to illness duration. Ordinal logistic regression was used to describe the association between illness duration at baseline and CGI-S outcome score at 2 years, following adjustment for CGI-S start score and other key covariates. Results: Among the 401 patients included, there was an association between illness duration and CGI-S outcome score with a 4% increase in the odds of a higher (worse) outcome CGI-S score per year of illness [adjusted odds ratio (AOR) = 1.04; 95% confidence interval (CI): 1.01–1.06]. The association between illness duration and clozapine response was most marked at less than 4 years illness duration. There were too few clozapine initiations within the first 2 years of illness to draw any conclusions about early clozapine initiation. Conclusion: Initiation of clozapine within 2–4 years of psychotic illness onset offers the best outcome for TRS, but the advantage, if any, of earlier initiation is unclear from these data.https://doi.org/10.1177/20451253221103353 |
| spellingShingle | Rowena Jones Rachel Upthegrove Malcolm J. Price Megan Pritchard Joht Singh Chandan Sophie Legge James H. MacCabe Duration of prior psychotic illness and clozapine response: a retrospective observational study using electronic health records Therapeutic Advances in Psychopharmacology |
| title | Duration of prior psychotic illness and clozapine response: a retrospective observational study using electronic health records |
| title_full | Duration of prior psychotic illness and clozapine response: a retrospective observational study using electronic health records |
| title_fullStr | Duration of prior psychotic illness and clozapine response: a retrospective observational study using electronic health records |
| title_full_unstemmed | Duration of prior psychotic illness and clozapine response: a retrospective observational study using electronic health records |
| title_short | Duration of prior psychotic illness and clozapine response: a retrospective observational study using electronic health records |
| title_sort | duration of prior psychotic illness and clozapine response a retrospective observational study using electronic health records |
| url | https://doi.org/10.1177/20451253221103353 |
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