An eight-year clinic experience with clozapine use in a Parkinson's disease clinic setting.

<h4>Background</h4>To examine our eight year clinic-based experience in a Parkinson's disease expert clinical care center using clozapine as a treatment for refractory psychosis in Parkinson's disease (PD).<h4>Methods</h4>The study was a retrospective chart review w...

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Autores principales: Nawaz Hack, Sarah M Fayad, Erin H Monari, Umer Akbar, Angela Hardwick, Ramon L Rodriguez, Irene A Malaty, Janet Romrell, Aparna A Wagle Shukla, Nikolaus McFarland, Herbert E Ward, Michael S Okun
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Publicado: Public Library of Science (PLoS) 2014
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spelling oai:doaj.org-article:ffe5b2d2639649b7a94244aa1b73384c2021-11-18T08:27:24ZAn eight-year clinic experience with clozapine use in a Parkinson's disease clinic setting.1932-620310.1371/journal.pone.0091545https://doaj.org/article/ffe5b2d2639649b7a94244aa1b73384c2014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24646688/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>To examine our eight year clinic-based experience in a Parkinson's disease expert clinical care center using clozapine as a treatment for refractory psychosis in Parkinson's disease (PD).<h4>Methods</h4>The study was a retrospective chart review which covered eight years of clozapine registry use. Statistical T-tests, chi-square, correlations and regression analysis were used to analyze treatment response for potential associations of age, disease duration, and Hoehn & Yahr (H&Y) score, and degree of response to clozapine therapy.<h4>Results</h4>There were 36 participants included in the analysis (32 PD, 4 parkinsonism-plus). The characteristics included 30.6% female, age 45-87 years (mean 68.3±10.15), disease duration of 17-240 months (mean 108.14±51.13) and H&Y score of 2 to 4 (mean 2.51±0.51). The overall retention rate on clozapine was 41% and the most common reasons for discontinuation were frequent blood testing (28%), nursing home (NH) placement (11%) and leucopenia (8%). Responses to clozapine across the cohort were: complete (33%), partial (33%), absent (16%), and unknown (16%). Age (r = -0.36, p<0.01) and H&Y score (r = -0.41, p<0.01) were shown to be related to response to clozapine therapy, but disease duration was not an associated factor (r = 0.21, p>0.05).<h4>Conclusions</h4>This single-center experience highlights the challenges associated with clozapine therapy in PD psychosis. Frequent blood testing remains a significant barrier for clozapine, even in patients with therapeutic benefit. Surprisingly, all patients admitted to a NH discontinued clozapine due to logistical issues of administration and monitoring within that setting. Consideration of the barriers to clozapine therapy will be important to its use and to its continued success in an outpatient setting.Nawaz HackSarah M FayadErin H MonariUmer AkbarAngela HardwickRamon L RodriguezIrene A MalatyJanet RomrellAparna A Wagle ShuklaNikolaus McFarlandHerbert E WardMichael S OkunPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 3, p e91545 (2014)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Nawaz Hack
Sarah M Fayad
Erin H Monari
Umer Akbar
Angela Hardwick
Ramon L Rodriguez
Irene A Malaty
Janet Romrell
Aparna A Wagle Shukla
Nikolaus McFarland
Herbert E Ward
Michael S Okun
An eight-year clinic experience with clozapine use in a Parkinson's disease clinic setting.
description <h4>Background</h4>To examine our eight year clinic-based experience in a Parkinson's disease expert clinical care center using clozapine as a treatment for refractory psychosis in Parkinson's disease (PD).<h4>Methods</h4>The study was a retrospective chart review which covered eight years of clozapine registry use. Statistical T-tests, chi-square, correlations and regression analysis were used to analyze treatment response for potential associations of age, disease duration, and Hoehn & Yahr (H&Y) score, and degree of response to clozapine therapy.<h4>Results</h4>There were 36 participants included in the analysis (32 PD, 4 parkinsonism-plus). The characteristics included 30.6% female, age 45-87 years (mean 68.3±10.15), disease duration of 17-240 months (mean 108.14±51.13) and H&Y score of 2 to 4 (mean 2.51±0.51). The overall retention rate on clozapine was 41% and the most common reasons for discontinuation were frequent blood testing (28%), nursing home (NH) placement (11%) and leucopenia (8%). Responses to clozapine across the cohort were: complete (33%), partial (33%), absent (16%), and unknown (16%). Age (r = -0.36, p<0.01) and H&Y score (r = -0.41, p<0.01) were shown to be related to response to clozapine therapy, but disease duration was not an associated factor (r = 0.21, p>0.05).<h4>Conclusions</h4>This single-center experience highlights the challenges associated with clozapine therapy in PD psychosis. Frequent blood testing remains a significant barrier for clozapine, even in patients with therapeutic benefit. Surprisingly, all patients admitted to a NH discontinued clozapine due to logistical issues of administration and monitoring within that setting. Consideration of the barriers to clozapine therapy will be important to its use and to its continued success in an outpatient setting.
format article
author Nawaz Hack
Sarah M Fayad
Erin H Monari
Umer Akbar
Angela Hardwick
Ramon L Rodriguez
Irene A Malaty
Janet Romrell
Aparna A Wagle Shukla
Nikolaus McFarland
Herbert E Ward
Michael S Okun
author_facet Nawaz Hack
Sarah M Fayad
Erin H Monari
Umer Akbar
Angela Hardwick
Ramon L Rodriguez
Irene A Malaty
Janet Romrell
Aparna A Wagle Shukla
Nikolaus McFarland
Herbert E Ward
Michael S Okun
author_sort Nawaz Hack
title An eight-year clinic experience with clozapine use in a Parkinson's disease clinic setting.
title_short An eight-year clinic experience with clozapine use in a Parkinson's disease clinic setting.
title_full An eight-year clinic experience with clozapine use in a Parkinson's disease clinic setting.
title_fullStr An eight-year clinic experience with clozapine use in a Parkinson's disease clinic setting.
title_full_unstemmed An eight-year clinic experience with clozapine use in a Parkinson's disease clinic setting.
title_sort eight-year clinic experience with clozapine use in a parkinson's disease clinic setting.
publisher Public Library of Science (PLoS)
publishDate 2014
url https://doaj.org/article/ffe5b2d2639649b7a94244aa1b73384c
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