Risk of neutropenia among clozapine users and non-users : results from 5,847 patients
Autor(a) principal: | |
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Data de Publicação: | 2022 |
Outros Autores: | , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UFRGS |
Texto Completo: | http://hdl.handle.net/10183/272897 |
Resumo: | Objective: Clozapine is underprescribed due to neutropenia risk. Blood tests every 3 months in those on continuous treatment for > 1 year who have never had an absolute neutrophil count (ANC) < 2,000/µL has been proposed as a monitoring strategy; however, there are no South American data to support this recommendation. This study sought to investigate whether clozapine use and other variables could explain the occurrence of ANC < 1,000/µL in patients with severe mental disorders. Methods: A total of 5,847 subjects were included, 1,038 on clozapine. We performed a Cox regression considering the outcome as ANC < 1,000/µL at any time point. Predictors were sex, age, ethnicity, clozapine use, ANC > 2,000/µL during the first year of blood monitoring, and presence of a severe medical condition. Results: In the Cox regression model, ethnicity (white) (hazard ratio [HR] 0.53; 95%CI 0.29-0.99, p < 0.05) and ANC > 2,000/µL (HR 0.04; 95%CI 0.01-0.10, p < 0.001) were protective factors, while presence of a severe medical condition (HR 69.35; 95%CI 37.45-128.44, p < 0.001) was a risk factor for ANC < 1,000/µL. Other variables were not significant, including clozapine use (HR 1.33; 95%CI 0.74-2.39, p > 0.05). Conclusions: These findings suggest that clozapine does not increase the risk of neutropenia in subjects with ANC > 2,000/µL during the first year of use and in the absence of a severe medical condition. These results could help guide clinical and public-health decisions regarding clozapine blood monitoring guidelines. |
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Goldani, Andre Akira SuenoPonte, Francisco Diego Rabelo daFeiten, Jacson GabrielLobato, Maria Inês RodriguesBelmonte-de-Abreu, Paulo SilvaGama, Clarissa Severino2024-03-05T04:37:00Z20221516-4446http://hdl.handle.net/10183/272897001194939Objective: Clozapine is underprescribed due to neutropenia risk. Blood tests every 3 months in those on continuous treatment for > 1 year who have never had an absolute neutrophil count (ANC) < 2,000/µL has been proposed as a monitoring strategy; however, there are no South American data to support this recommendation. This study sought to investigate whether clozapine use and other variables could explain the occurrence of ANC < 1,000/µL in patients with severe mental disorders. Methods: A total of 5,847 subjects were included, 1,038 on clozapine. We performed a Cox regression considering the outcome as ANC < 1,000/µL at any time point. Predictors were sex, age, ethnicity, clozapine use, ANC > 2,000/µL during the first year of blood monitoring, and presence of a severe medical condition. Results: In the Cox regression model, ethnicity (white) (hazard ratio [HR] 0.53; 95%CI 0.29-0.99, p < 0.05) and ANC > 2,000/µL (HR 0.04; 95%CI 0.01-0.10, p < 0.001) were protective factors, while presence of a severe medical condition (HR 69.35; 95%CI 37.45-128.44, p < 0.001) was a risk factor for ANC < 1,000/µL. Other variables were not significant, including clozapine use (HR 1.33; 95%CI 0.74-2.39, p > 0.05). Conclusions: These findings suggest that clozapine does not increase the risk of neutropenia in subjects with ANC > 2,000/µL during the first year of use and in the absence of a severe medical condition. These results could help guide clinical and public-health decisions regarding clozapine blood monitoring guidelines.application/pdfengRevista brasileira de psiquiatria (1999). São Paulo. Vol. 44, no. 1 (Jan./Feb. 2022), p. 21-25ClozapinaNeutropeniaTestes hematológicosContagem de células sanguíneasNeutrófilosClozapineHematological monitoringHemogramAbsolute neutrophil countRisk of neutropenia among clozapine users and non-users : results from 5,847 patientsinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/otherinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFRGSinstname:Universidade Federal do Rio Grande do Sul (UFRGS)instacron:UFRGSTEXT001194939.pdf.txt001194939.pdf.txtExtracted Texttext/plain23207http://www.lume.ufrgs.br/bitstream/10183/272897/2/001194939.pdf.txtc66dbdab5e67ef069116bb8f19f5077eMD52ORIGINAL001194939.pdfTexto completo (inglês)application/pdf124262http://www.lume.ufrgs.br/bitstream/10183/272897/1/001194939.pdfbf43f699d3bd8aa3e47bed4170ff8a95MD5110183/2728972024-03-06 04:55:46.050328oai:www.lume.ufrgs.br:10183/272897Repositório de PublicaçõesPUBhttps://lume.ufrgs.br/oai/requestopendoar:2024-03-06T07:55:46Repositório Institucional da UFRGS - Universidade Federal do Rio Grande do Sul (UFRGS)false |
dc.title.pt_BR.fl_str_mv |
Risk of neutropenia among clozapine users and non-users : results from 5,847 patients |
title |
Risk of neutropenia among clozapine users and non-users : results from 5,847 patients |
spellingShingle |
Risk of neutropenia among clozapine users and non-users : results from 5,847 patients Goldani, Andre Akira Sueno Clozapina Neutropenia Testes hematológicos Contagem de células sanguíneas Neutrófilos Clozapine Hematological monitoring Hemogram Absolute neutrophil count |
title_short |
Risk of neutropenia among clozapine users and non-users : results from 5,847 patients |
title_full |
Risk of neutropenia among clozapine users and non-users : results from 5,847 patients |
title_fullStr |
Risk of neutropenia among clozapine users and non-users : results from 5,847 patients |
title_full_unstemmed |
Risk of neutropenia among clozapine users and non-users : results from 5,847 patients |
title_sort |
Risk of neutropenia among clozapine users and non-users : results from 5,847 patients |
author |
Goldani, Andre Akira Sueno |
author_facet |
Goldani, Andre Akira Sueno Ponte, Francisco Diego Rabelo da Feiten, Jacson Gabriel Lobato, Maria Inês Rodrigues Belmonte-de-Abreu, Paulo Silva Gama, Clarissa Severino |
author_role |
author |
author2 |
Ponte, Francisco Diego Rabelo da Feiten, Jacson Gabriel Lobato, Maria Inês Rodrigues Belmonte-de-Abreu, Paulo Silva Gama, Clarissa Severino |
author2_role |
author author author author author |
dc.contributor.author.fl_str_mv |
Goldani, Andre Akira Sueno Ponte, Francisco Diego Rabelo da Feiten, Jacson Gabriel Lobato, Maria Inês Rodrigues Belmonte-de-Abreu, Paulo Silva Gama, Clarissa Severino |
dc.subject.por.fl_str_mv |
Clozapina Neutropenia Testes hematológicos Contagem de células sanguíneas Neutrófilos |
topic |
Clozapina Neutropenia Testes hematológicos Contagem de células sanguíneas Neutrófilos Clozapine Hematological monitoring Hemogram Absolute neutrophil count |
dc.subject.eng.fl_str_mv |
Clozapine Hematological monitoring Hemogram Absolute neutrophil count |
description |
Objective: Clozapine is underprescribed due to neutropenia risk. Blood tests every 3 months in those on continuous treatment for > 1 year who have never had an absolute neutrophil count (ANC) < 2,000/µL has been proposed as a monitoring strategy; however, there are no South American data to support this recommendation. This study sought to investigate whether clozapine use and other variables could explain the occurrence of ANC < 1,000/µL in patients with severe mental disorders. Methods: A total of 5,847 subjects were included, 1,038 on clozapine. We performed a Cox regression considering the outcome as ANC < 1,000/µL at any time point. Predictors were sex, age, ethnicity, clozapine use, ANC > 2,000/µL during the first year of blood monitoring, and presence of a severe medical condition. Results: In the Cox regression model, ethnicity (white) (hazard ratio [HR] 0.53; 95%CI 0.29-0.99, p < 0.05) and ANC > 2,000/µL (HR 0.04; 95%CI 0.01-0.10, p < 0.001) were protective factors, while presence of a severe medical condition (HR 69.35; 95%CI 37.45-128.44, p < 0.001) was a risk factor for ANC < 1,000/µL. Other variables were not significant, including clozapine use (HR 1.33; 95%CI 0.74-2.39, p > 0.05). Conclusions: These findings suggest that clozapine does not increase the risk of neutropenia in subjects with ANC > 2,000/µL during the first year of use and in the absence of a severe medical condition. These results could help guide clinical and public-health decisions regarding clozapine blood monitoring guidelines. |
publishDate |
2022 |
dc.date.issued.fl_str_mv |
2022 |
dc.date.accessioned.fl_str_mv |
2024-03-05T04:37:00Z |
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info:eu-repo/semantics/article info:eu-repo/semantics/other |
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info:eu-repo/semantics/publishedVersion |
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publishedVersion |
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http://hdl.handle.net/10183/272897 |
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1516-4446 |
dc.identifier.nrb.pt_BR.fl_str_mv |
001194939 |
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dc.language.iso.fl_str_mv |
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dc.relation.ispartof.pt_BR.fl_str_mv |
Revista brasileira de psiquiatria (1999). São Paulo. Vol. 44, no. 1 (Jan./Feb. 2022), p. 21-25 |
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