Older patients with schizophrenia who take clozapine may have a lower risk of death than those who take several other atypical antipsychotics, a study in the American Journal of Geriatric Psychiatry suggests. However, the study also found that there was no significant difference between clozapine and ziprasidone with respect to mortality.
Júlio César Menezes Vieira, M.Sc., of the Federal University of Minas Gerais in Brazil, and colleagues analyzed data from 83,284 Brazilian patients ages 60 years and older who were diagnosed with schizophrenia and received their first atypical antipsychotic from the Brazilian National Health System between 2000 and 2014. The antipsychotics prescribed included clozapine, risperidone, quetiapine, olanzapine, and ziprasidone. Patients were followed until December 31, 2015.
Overall, the 15-year (180-month) survival rate among these older patients was 18.4%, with a median survival time of 31 months. When compared with all non-clozapine antipsychotics as a group, clozapine was associated with a higher median survival time (38 months versus 31 months), higher 100-month survival rate (55.6% versus 39.4%), and higher 180-month survival rate (32.5% versus 18.1%). Among all individual antipsychotics, ziprasidone had the highest median survival time of 44 months, while quetiapine had the lowest at 26 months.
Patients who took quetiapine, risperidone, and olanzapine had an 80%, 69%, and 12% greater risk of dying, respectively, during the complete 16-year follow-up than those who took clozapine. There was no statistically significant difference in the risk of dying between those who took clozapine and those who took ziprasidone.
The researchers noted that clozapine is not the first antipsychotic of choice for older patients with psychosis because of its adverse effects and tolerability: Older patients have four times the risk of clozapine-induced neutropenia/agranulocytosis compared with younger patients, and clozapine has been linked to increased cardiovascular and metabolic risks.
“To ensure safe clozapine management in older patients, comorbidities must be medically assessed before introducing the antipsychotic, in addition to monitoring side effects and conducting regular complementary tests during treatment,” the researchers wrote. “Greater clozapine tolerability can be achieved in older adults through lower doses and slow titration.”
For related information, see the Psychiatric News article “FDA Has Ended the Clozapine REMS. What Happens Now?”
(Image: Getty Images/iStock/uchar)
Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.