Clozapine treatment and discontinuation in Iceland: A national longitudinal study using electronic patient records

Background: Clozapine is the only drug approved for treatment-resistant schizophrenia. There is evidence that clozapine is underutilized. Aims: To evaluate the initiation and discontinuation of clozapine at Landspitali University Hospital in Iceland and the prevalence of antipsychotic polypharmacy i...

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Published in:Nordic journal of psychiatry 2016-08, Vol.70 (6), p.450-455
Main Authors: Ingimarsson, Oddur, MacCabe, James H., Haraldsson, Magnús, Jónsdóttir, Halldóra, Sigurdsson, Engilbert
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Antipsychotic Agents - therapeutic use
Antipsychotics
Clozapine
Clozapine - therapeutic use
Cohort Studies
Electronic Health Records - trends
Female
Follow-Up Studies
Humans
Iceland - epidemiology
Longitudinal Studies
Male
Middle Aged
Polypharmacy
Schizophrenia
Schizophrenia - drug therapy
Schizophrenia - epidemiology
Treatment-resistant
Withholding Treatment - trends
Young Adult
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Summary:Background: Clozapine is the only drug approved for treatment-resistant schizophrenia. There is evidence that clozapine is underutilized. Aims: To evaluate the initiation and discontinuation of clozapine at Landspitali University Hospital in Iceland and the prevalence of antipsychotic polypharmacy in clozapine-treated patients. Methods: The study is a part of an ongoing longitudinal study of schizophrenia in Iceland. We identified 201 patients on clozapine or who have been on clozapine by using a keyword search in the electronic health records and by reviewing their medical records. Results: Mean age at first treatment with clozapine was 37.8 years. Mean follow-up period on clozapine was 11 years. After 20 years of treatment 71.2% of patients were still on clozapine. After one year of treatment 84.4% of patients were still receiving clozapine treatment. We estimate that 11.4% of patients with schizophrenia in Iceland are taking clozapine and that 16% have been treated with clozapine at some point. Polypharmacy is common, since nearly 2/3, 65.6%, of patients taking clozapine use at least one other antipsychotic and 16.9% are also receiving depot injections. Conclusions: We need to increase the awareness of psychiatrists in Iceland with regard to treatment with clozapine, since only about half of the estimated population of patients with treatment-resistant schizophrenia in Iceland have ever been treated with clozapine. Nearly two thirds of patients who are prescribed clozapine in Iceland remain on it long-term.
ISSN:0803-9488
1502-4725
DOI:10.3109/08039488.2016.1155234