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The results should reassure clinicians concerned about the safety of long-term use of clozapine, especially with regard to cardiovascular-related adverse effects, wrote Jentien M. Vermeulen, M.D., of the University of Amsterdam and colleagues. “Combined with the known superior efficacy of clozapine for treatment-resistant schizophrenia, [this finding] is clinically highly relevant and may lead to alleviation of earlier concerns about the mortality risk when switching patients to clozapine.”
Vermeulen and colleagues systematically searched the medical literature for studies that followed patients at least 52 weeks and reported on mortality in adults diagnosed with schizophrenia-spectrum disorders who had received clozapine treatment continuously or at any time during the follow-up.
A total of 1,327 deaths from any causes were reported for patients with schizophrenia-spectrum disorders across 24 studies, eight of which compared patients exposed to clozapine with patients exposed to other antipsychotics. The studies including patients treated with clozapine continuously during follow-up had a median length of 7.2 years, and the studies including patients who ever used clozapine during follow-up had a median length of 5.9 years.
The long-term risk of death from any cause was significantly lower for patients continuously exposed to clozapine compared with patients continuously exposed to other antipsychotics. There was no significant difference in long-term mortality rates between patients who ever took clozapine but did not take it continuously throughout follow-up and those who took other antipsychotics.
The researchers said the findings suggest that the continuous effects of clozapine are most beneficial for prolonging life expectancy and that this effect seems to be diminished or lost when clozapine is discontinued.
For related information, see the Psychiatric News article “Clozapine, LAI Antipsychotics Found Best at Preventing Relapse.”
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