Reduction in Absolute Neutrophil Counts in Patient on Clozapine Infected with COVID-19

Despite its severe adverse effects, such as agranulocytosis, clozapine is the primary treatment for treatment-resistant schizophrenia. The established clozapine monitoring system has contributed to reducing agranulocytosis incidence and mortality rates. However, the pandemic coronavirus disease 2019...

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Autores principales:	Fitri Fareez Ramli, Adli Ali, Syed Alhafiz Syed Hashim, Yusof Kamisah, Normala Ibrahim
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	clozapine coronavirus schizophrenia Medicine R
Acceso en línea:	https://doaj.org/article/3c56692ef4534d3395caf38bd4a91c5e
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spelling	oai:doaj.org-article:3c56692ef4534d3395caf38bd4a91c5e2021-11-11T16:26:34ZReduction in Absolute Neutrophil Counts in Patient on Clozapine Infected with COVID-1910.3390/ijerph1821112891660-46011661-7827https://doaj.org/article/3c56692ef4534d3395caf38bd4a91c5e2021-10-01T00:00:00Zhttps://www.mdpi.com/1660-4601/18/21/11289https://doaj.org/toc/1661-7827https://doaj.org/toc/1660-4601Despite its severe adverse effects, such as agranulocytosis, clozapine is the primary treatment for treatment-resistant schizophrenia. The established clozapine monitoring system has contributed to reducing agranulocytosis incidence and mortality rates. However, the pandemic coronavirus disease 2019 (COVID-19) has caused changes in the monitoring system. This review aimed to assess the current evidence on the neutrophil changes in the patient on clozapine treatment and infected with COVID-19. Individual cases reported various absolute neutrophil count (ANC) levels, normal, reduced, or elevated. No agranulocytosis case was reported. One case had a borderline moderate-severe ANC level, but the patient was in the 18-week period of clozapine treatment. A cumulative analysis of case the series initially reported inconclusive results. However, a more recent study with a larger sample size reported a significant reduction in the ANC during COVID-19 infection. Nevertheless, this effect is transient as no significant difference was found between the baseline and the post-infection period in ANC levels. In conclusion, COVID-19 is associated with a temporary reduction in ANC levels. The results supported the recommendation to reduce the frequency of clozapine monitoring in the eligible candidates. However, more data are required to confirm the current findings given the limitations, including study design, sample size, and statistical analysis.Fitri Fareez RamliAdli AliSyed Alhafiz Syed HashimYusof KamisahNormala IbrahimMDPI AGarticleclozapinecoronavirusschizophreniaMedicineRENInternational Journal of Environmental Research and Public Health, Vol 18, Iss 11289, p 11289 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	clozapine coronavirus schizophrenia Medicine R
spellingShingle	clozapine coronavirus schizophrenia Medicine R Fitri Fareez Ramli Adli Ali Syed Alhafiz Syed Hashim Yusof Kamisah Normala Ibrahim Reduction in Absolute Neutrophil Counts in Patient on Clozapine Infected with COVID-19
description	Despite its severe adverse effects, such as agranulocytosis, clozapine is the primary treatment for treatment-resistant schizophrenia. The established clozapine monitoring system has contributed to reducing agranulocytosis incidence and mortality rates. However, the pandemic coronavirus disease 2019 (COVID-19) has caused changes in the monitoring system. This review aimed to assess the current evidence on the neutrophil changes in the patient on clozapine treatment and infected with COVID-19. Individual cases reported various absolute neutrophil count (ANC) levels, normal, reduced, or elevated. No agranulocytosis case was reported. One case had a borderline moderate-severe ANC level, but the patient was in the 18-week period of clozapine treatment. A cumulative analysis of case the series initially reported inconclusive results. However, a more recent study with a larger sample size reported a significant reduction in the ANC during COVID-19 infection. Nevertheless, this effect is transient as no significant difference was found between the baseline and the post-infection period in ANC levels. In conclusion, COVID-19 is associated with a temporary reduction in ANC levels. The results supported the recommendation to reduce the frequency of clozapine monitoring in the eligible candidates. However, more data are required to confirm the current findings given the limitations, including study design, sample size, and statistical analysis.
format	article
author	Fitri Fareez Ramli Adli Ali Syed Alhafiz Syed Hashim Yusof Kamisah Normala Ibrahim
author_facet	Fitri Fareez Ramli Adli Ali Syed Alhafiz Syed Hashim Yusof Kamisah Normala Ibrahim
author_sort	Fitri Fareez Ramli
title	Reduction in Absolute Neutrophil Counts in Patient on Clozapine Infected with COVID-19
title_short	Reduction in Absolute Neutrophil Counts in Patient on Clozapine Infected with COVID-19
title_full	Reduction in Absolute Neutrophil Counts in Patient on Clozapine Infected with COVID-19
title_fullStr	Reduction in Absolute Neutrophil Counts in Patient on Clozapine Infected with COVID-19
title_full_unstemmed	Reduction in Absolute Neutrophil Counts in Patient on Clozapine Infected with COVID-19
title_sort	reduction in absolute neutrophil counts in patient on clozapine infected with covid-19
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/3c56692ef4534d3395caf38bd4a91c5e
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Reduction in Absolute Neutrophil Counts in Patient on Clozapine Infected with COVID-19

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