Clinical predictors of response to clozapine in Tunisian patients with treatment resistant schizophrenia

Introduction: Treatment resistant schizophrenia (TRS), affecting approximately one-third of patients with schizophrenia, is associated with a serious impairment in global psychosocial functioning. Clozapine is the only licensed drug for TRS. However its prescription remains limited by its side effec...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Amina Aissa, Rahma Jouini, Uta Ouali, Yosra Zgueb, Fethi Nacef, Zouhaier El Hechmi
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2022
Materias:	Schizophrenia Cross-sectional studies Clozapine Treatment resistant Therapeutics Prognosis Psychiatry RC435-571
Acceso en línea:	https://doaj.org/article/7feafd787a884556b7db28dda7fe9cc6
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:7feafd787a884556b7db28dda7fe9cc6
record_format	dspace
spelling	oai:doaj.org-article:7feafd787a884556b7db28dda7fe9cc62021-11-10T04:17:13ZClinical predictors of response to clozapine in Tunisian patients with treatment resistant schizophrenia0010-440X10.1016/j.comppsych.2021.152280https://doaj.org/article/7feafd787a884556b7db28dda7fe9cc62022-01-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S0010440X21000584https://doaj.org/toc/0010-440XIntroduction: Treatment resistant schizophrenia (TRS), affecting approximately one-third of patients with schizophrenia, is associated with a serious impairment in global psychosocial functioning. Clozapine is the only licensed drug for TRS. However its prescription remains limited by its side effects requiring mandatory monitoring. The need to identify clinical factors associated with good response to clozapine in TRS has been established. The presence of ethnic differences in these factors and the scarcity of data on the Tunisian or more generally the North-African population warrants the conduct of a clinical study on the subject. The aim of this study was to investigate demographic, clinical, and biochemical patient characteristics as potential predictors of response to clozapine. Methods: This is a cross-sectional and retrospective study, at the “F and A psychiatry departments” of Razi Hospital in Manouba, Tunisia. All patients, with DSM 5 diagnosis of schizophrenia in its resistant form, on clozapine for at least 12 months and who consulted from June 1, 2018 to November 30, 2018 were included. We investigated premorbid functioning by the premorbid adjusment scale, demographic and clinical characteristics, and clozapine plasma level as potential clozapine response predictors. The response to clozapine was defined by a total BPRS score of 35 or less. Results: Sixty-three patients were included in the study. The mean age at clozapine introduction was 30,84 ±9,25 years. The mean duration of clozapine treatment was 7,22 ± 4,02 years.There were 16 clozapine responders (25%) who had BPRS total scores below or equal to 35 and 47 non-responders (75%).A higher premorbid social functioning in childhood (p = 0,018) and early adolescence (p = 0,024) was associated with better response to clozapine. A delay clozapine initiation shorter than 7 years(p = 0,036), one atypical antipsychotic trial (p = 0,029) and schizophrenia paranoid subtype (p< 0.01) were found to be significantly predictive of good clozapine response. None of the demographic factors or biochemical characteristics were associated with clozapine response. Conclusions: Our work is consistent with previous studies suggesting the need for clinicians to be aware of the clinical predictors of a good response to clozapine to overcome their reluctance to prescribe it. It also highlighted the major prognostic role of premorbid adjustment in the clinical response to treatment. However, prospective studies including therapeutic drug monitoring would be very useful to better delineate the sub-group of patients to whom clozapine would benefit the most and to improve prescription modalities.Amina AissaRahma JouiniUta OualiYosra ZguebFethi NacefZouhaier El HechmiElsevierarticleSchizophreniaCross-sectional studiesClozapineTreatment resistantTherapeuticsPrognosisPsychiatryRC435-571ENComprehensive Psychiatry, Vol 112, Iss , Pp 152280- (2022)
institution	DOAJ
collection	DOAJ
language	EN
topic	Schizophrenia Cross-sectional studies Clozapine Treatment resistant Therapeutics Prognosis Psychiatry RC435-571
spellingShingle	Schizophrenia Cross-sectional studies Clozapine Treatment resistant Therapeutics Prognosis Psychiatry RC435-571 Amina Aissa Rahma Jouini Uta Ouali Yosra Zgueb Fethi Nacef Zouhaier El Hechmi Clinical predictors of response to clozapine in Tunisian patients with treatment resistant schizophrenia
description	Introduction: Treatment resistant schizophrenia (TRS), affecting approximately one-third of patients with schizophrenia, is associated with a serious impairment in global psychosocial functioning. Clozapine is the only licensed drug for TRS. However its prescription remains limited by its side effects requiring mandatory monitoring. The need to identify clinical factors associated with good response to clozapine in TRS has been established. The presence of ethnic differences in these factors and the scarcity of data on the Tunisian or more generally the North-African population warrants the conduct of a clinical study on the subject. The aim of this study was to investigate demographic, clinical, and biochemical patient characteristics as potential predictors of response to clozapine. Methods: This is a cross-sectional and retrospective study, at the “F and A psychiatry departments” of Razi Hospital in Manouba, Tunisia. All patients, with DSM 5 diagnosis of schizophrenia in its resistant form, on clozapine for at least 12 months and who consulted from June 1, 2018 to November 30, 2018 were included. We investigated premorbid functioning by the premorbid adjusment scale, demographic and clinical characteristics, and clozapine plasma level as potential clozapine response predictors. The response to clozapine was defined by a total BPRS score of 35 or less. Results: Sixty-three patients were included in the study. The mean age at clozapine introduction was 30,84 ±9,25 years. The mean duration of clozapine treatment was 7,22 ± 4,02 years.There were 16 clozapine responders (25%) who had BPRS total scores below or equal to 35 and 47 non-responders (75%).A higher premorbid social functioning in childhood (p = 0,018) and early adolescence (p = 0,024) was associated with better response to clozapine. A delay clozapine initiation shorter than 7 years(p = 0,036), one atypical antipsychotic trial (p = 0,029) and schizophrenia paranoid subtype (p< 0.01) were found to be significantly predictive of good clozapine response. None of the demographic factors or biochemical characteristics were associated with clozapine response. Conclusions: Our work is consistent with previous studies suggesting the need for clinicians to be aware of the clinical predictors of a good response to clozapine to overcome their reluctance to prescribe it. It also highlighted the major prognostic role of premorbid adjustment in the clinical response to treatment. However, prospective studies including therapeutic drug monitoring would be very useful to better delineate the sub-group of patients to whom clozapine would benefit the most and to improve prescription modalities.
format	article
author	Amina Aissa Rahma Jouini Uta Ouali Yosra Zgueb Fethi Nacef Zouhaier El Hechmi
author_facet	Amina Aissa Rahma Jouini Uta Ouali Yosra Zgueb Fethi Nacef Zouhaier El Hechmi
author_sort	Amina Aissa
title	Clinical predictors of response to clozapine in Tunisian patients with treatment resistant schizophrenia
title_short	Clinical predictors of response to clozapine in Tunisian patients with treatment resistant schizophrenia
title_full	Clinical predictors of response to clozapine in Tunisian patients with treatment resistant schizophrenia
title_fullStr	Clinical predictors of response to clozapine in Tunisian patients with treatment resistant schizophrenia
title_full_unstemmed	Clinical predictors of response to clozapine in Tunisian patients with treatment resistant schizophrenia
title_sort	clinical predictors of response to clozapine in tunisian patients with treatment resistant schizophrenia
publisher	Elsevier
publishDate	2022
url	https://doaj.org/article/7feafd787a884556b7db28dda7fe9cc6
work_keys_str_mv	AT aminaaissa clinicalpredictorsofresponsetoclozapineintunisianpatientswithtreatmentresistantschizophrenia AT rahmajouini clinicalpredictorsofresponsetoclozapineintunisianpatientswithtreatmentresistantschizophrenia AT utaouali clinicalpredictorsofresponsetoclozapineintunisianpatientswithtreatmentresistantschizophrenia AT yosrazgueb clinicalpredictorsofresponsetoclozapineintunisianpatientswithtreatmentresistantschizophrenia AT fethinacef clinicalpredictorsofresponsetoclozapineintunisianpatientswithtreatmentresistantschizophrenia AT zouhaierelhechmi clinicalpredictorsofresponsetoclozapineintunisianpatientswithtreatmentresistantschizophrenia
_version_	1718440667717304320

Clinical predictors of response to clozapine in Tunisian patients with treatment resistant schizophrenia

Ejemplares similares