101
|
Shah P, Kim FJ, Mian BM. Genitourinary cancer management during a severe pandemic: Utility of rapid communication tools and evidence-based guidelines. BJUI COMPASS 2020; 1:45-59. [PMID: 32537615 PMCID: PMC7280667 DOI: 10.1002/bco2.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 01/03/2023] Open
Abstract
Objectives: To determine the usefulness of social media for rapid communication with experts to discuss strategies for prioritization and safety of deferred treatment for urologic malignancies during COVID‐19 pandemic, and to determine whether the discourse and recommendations made through discussions on social media (Twitter) were consistent with the current peer‐reviewed literature regarding the safety of delayed treatment. Methods: We reviewed and compiled the responses to our questions on Twitter regarding the management and safety of deferred treatment in the setting of COVID‐19 related constraints on non‐urgent care. We chronicled the guidance published on this subject by various health authorities and professional organizations. Further, we analyzed peerreviewed literature on the safety of deferred treatment (surgery or systemic therapy) to make made evidence‐based recommendations. Results: Due to the rapidly changing information about epidemiology and infectious characteristics of COVID‐19, the health authorities and professional societies guidance required frequent revisions which by design take days or weeks to produce. Several active discussions on Twitter provided real‐time updates on the changing landscape of the restrictions being placed on non‐urgent care. For separate discussion threads on prostate cancer and bladder cancer, dozens of specialists with expertise in treating urologic cancers could be engaged in providing their expert opinions as well as share evidence to support their recommendations. Our analysis of published studies addressing the safety and extent to which delayed cancer care does not compromise oncological outcome revealed that most prostate cancer care and certain aspects of the bladder and kidney cancer care can be safely deferred for 2‐6 months. Urothelial bladder cancer and advanced kidney cancer require a higher priority for timely surgical care. We did not find evidence to support the idea of using nonsurgical therapies, such as hormone therapy for prostate cancer or chemotherapy for bladder cancer for safer deferment of previously planned surgery. We noted that the comments and recommendations made by the participants in the Twitter discussions were generally consistent with our evidence‐based recommendations for safely postponing cancer care for certain types of urologic cancers. Conclusion: The use of social media platforms, such as Twitter, where the comments and recommendations are subject to review and critique by other specialists is not only feasible but quite useful in addressing the situations requiring urgent resolution, often supported by published evidence. In circumstances such as natural disasters, this may be a preferable approach than the traditional expert panels due to its ability to harness the collective intellect to available experts to provide responses and solutions in real‐time. These real‐time communications via Twitter provided sound guidance which was readily available to the public and participants, and was generally in concordance with the peerreviewed data on safety of deferred treatment.
Collapse
|
102
|
Kalra S, Ghosh S, Das AK, Nair T, Bajaj S, Priya G, Mehrotra RN, Das S, Shah P, Deshmukh V, Chawla M, Sanyal D, Chandrasekaran S, Khandelwal D, Joshi A, Eliana F, Permana H, Fariduddin MD, Shrestha PK, Shrestha D, Kahandawa S, Sumanathilaka M, Shaheed A, Rahim AA, Orabi A, Al-Ani A, Hussein W, Kumar D, Shaikh K. Unravelling the utility of modern sulfonylureas from cardiovascular outcome trials and landmark trials: expert opinion from an international panel. Indian Heart J 2020; 72:7-13. [PMID: 32423565 PMCID: PMC7231843 DOI: 10.1016/j.ihj.2020.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/25/2019] [Accepted: 01/05/2020] [Indexed: 12/13/2022] Open
Abstract
AIM The primary objective of this review is to develop practice-based expert group opinions on the cardiovascular (CV) safety and utility of modern sulfonylureas (SUs) in cardiovascular outcome trials (CVOTs). BACKGROUND The United States Food and Drug Administration issued new guidance to the pharmaceutical industry in 2008 regarding the development of new antihyperglycemic drugs. The guidance expanded the scope for the approval of novel antihyperglycemic drugs by mandating CVOTs for safety. A few long-term CVOTs on dipeptidyl peptidase 4 inhibitors, glucagon-like peptide 1 receptor agonists, and sodium-glucose cotransporter 2 inhibitors have been completed, while others are ongoing. SUs, which constitute one of the key antihyperglycemic agents used for the management of type 2 diabetes mellitus (T2DM), have been used as comparator agents in several CVOTs. However, the need for CVOTs on modern SUs remains debatable. In this context, a multinational group of endocrinologists convened for a meeting and discussed the need for CVOTs of modern SUs to evaluate their utility in the management of patients with T2DM. At the meeting, CVOTs of modern SUs conducted to date and the hypotheses derived from the results of these trials were discussed. REVIEW RESULTS The expert group analyzed the key trials emphasizing the CV safety of modern SUs and also reviewed the results of various CVOTs in which modern SUs were used as comparators. Based on literature evidence and individual clinical insights, the expert group opined that modern SUs are cardiosafe and that since they have been used as comparators in other CVOTs, CVOTs of SUs are not required. CONCLUSION Modern SUs can be considered a cardiosafe option for the management of patients with diabetes mellitus and CV disease; thus CVOTs among individuals with T2DM are not required.
Collapse
|
103
|
Shah P, Plitman E, Iwata Y, Kim J, Nakajima S, Chan N, Brown EE, Caravaggio F, Torres E, Hahn M, Chakravarty MM, Remington G, Gerretsen P, Graff-Guerrero A. Glutamatergic neurometabolites and cortical thickness in treatment-resistant schizophrenia: Implications for glutamate-mediated excitotoxicity. J Psychiatr Res 2020; 124:151-158. [PMID: 32169688 DOI: 10.1016/j.jpsychires.2020.02.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/28/2020] [Accepted: 02/28/2020] [Indexed: 12/21/2022]
Abstract
Treatment-resistant schizophrenia may be related to structural brain alterations. However, the mechanisms underlying these changes remain unclear. The present study had two main aims: (1) to explore differences in cortical thickness between patients with treatment-resistant schizophrenia non-responsive to clozapine (ultra-treatment-resistant schizophrenia, UTRS), patients with treatment-resistant schizophrenia responsive to clozapine (Cloz-Resp), patients responsive to first-line non-clozapine antipsychotics (FL-Resp), and healthy controls (HCs); and (2) to test our hypothesis of structural compromise as a manifestation of neurotoxic effects from elevated glutamate (Glu) (i.e. glutamate-mediated excitotoxicity) by examining the relationships between glutamatergic neurometabolite levels (Glu and glutamate + glutamine (Glx)) in the dorsal anterior cingulate cortex (dACC) and cortical thickness. T1-weighted images and 1H-MRS data were obtained from UTRS (n = 24), Cloz-Resp (n = 25), FL-Resp (n = 19), and HCs (n = 26). Vertex-wise analyses showed that patients with UTRS had widespread cortical thinning in the bilateral frontal, temporal, parietal, and occipital gyri compared to HCs and FL-Resp patients. In the patient group, negative associations were found between dACC Glx levels and cortical thickness in the right dorsolateral prefrontal cortex after correcting for multiple comparisons and controlling for age, sex, antipsychotic dose, and illness severity. In conclusion, glutamate-mediated excitotoxicity may be one of the mechanisms underlying structural compromise seen in treatment-resistant schizophrenia. Future studies should longitudinally examine the associations between glutamatergic neurometabolite levels and cortical thickness in the context of treatment and illness progression.
Collapse
|
104
|
Kim J, Shah P, Quilty LC, Caravaggio F, Plitman E, Iwata Y, Pollock BG, Dash S, Sockalingam S, Graff-Guerrero A, Gerretsen P. DAS: The Diabetes Awareness and Insight Scale. Diabetes Metab Syndr 2020; 14:189-194. [PMID: 32145679 DOI: 10.1016/j.dsx.2020.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS Diabetes mellitus affects approximately 8.5% of the world's population with the majority of cases diagnosed with type 2 diabetes (T2DM). Impaired awareness or denial of T2DM is a common yet understudied construct that may negatively contribute to clinical outcomes. The aim of this study was to develop the Diabetes Awareness and Insight Scale (DAS), a self-report scale that measures illness awareness in persons with T2DM. METHODS Nine items were developed for the DAS that measure four domains of illness awareness, namely General Illness Awareness, Accurate Symptom Attribution, Awareness of Need for Treatment, and Awareness of Negative Consequences attributable to T2DM (www.illnessawarenessscales.com). A total of 100 participants with a diagnosis of T2DM were recruited using a digital data collection platform. RESULTS The DAS demonstrated good convergent and discriminant validity, internal consistency, and one-month test-retest reliability. An exploratory factor analysis showed that the DAS exhibited three factors. CONCLUSIONS Overall, the DAS is a novel and easy-to-administer scale that comprehensively measures subjective illness awareness in persons with T2DM. As the first scale of its kind, the DAS holds promise for use in epidemiology studies to examine the extent to which impaired illness awareness or illness denial contributes to clinical outcomes and T2DM management.
Collapse
|
105
|
Brusca S, Jang M, Shah P, Shah K, Hsu S, Feller E, E M, Najjar S, Fideli U, Kong H, Marishta A, Bhatti K, Yang Y, Tunc I, Solomon M, Berry G, Marboe C, Agbor-Enoh S, Valantine H. Early Donor-Derived Cell-Free DNA Predicts Peak Allograft Function in Heart Transplant. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
106
|
Krishnan A, Chidi A, Merlo C, Shah P, Ha J, Higgins R, Bush E. Lung Volume Reduction Surgery Prior to Lung Transplantation: A Propensity-Matched Analysis. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
107
|
Keller M, Shah P, Bush E, Diamond J, Matthews J, Brown A, Timofte I, Fideli U, Kong H, Marishta A, Bhatti K, Yang Y, Tunc I, Luikart H, Berry G, Marboe C, Iacono A, Nathan S, Khush K, Orens J, Jang M, Valentine H, Agbor-Enoh S. Donor-Derived-Cell-Free DNA to Identify Primary Graft Dysfunction Patients at Risk of Chronic Lung Allograft Dysfunction. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
108
|
Gerhard E, Singh R, Psotka M, Cavallo K, Genovese L, Cooper L, Edwards L, May C, Cole R, Sinha S, Desai S, Shah P. Long-Term Cardiac Remodeling after LVAD Deactivation for Myocardial Recovery. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
109
|
Cochrane A, Levine D, Ponor I, Philogene M, Jang M, Tunc I, Mathew J, Luikart H, Shah P, Khush K, Marboe C, Berry G, Valentine H, Agbor-Enoh S. Outcomes of ISHLT Lung Transplant AMR. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
110
|
Braun O, Brambatti M, Shah P, Cipriani M, Veenis J, Bui Q, Hong K, de Heyning C, Perna E, Timmermans P, Cikes M, Gjesdal G, Partida C, Potena L, Masetti M, Loforte A, Jakus N, Nilsson J, De Bock D, Minto J, Brugts J, Sterken C, Van den Bossche K, Rega F, Sing R, Russo C, Pretorius V, Klein L, Frigerio M, Adler E, Ammirati E. ICD Therapy Confers No Survival Advantage in a Global LVAD Population: Insights from the Trans-Atlantic Registry on VAD and Transplant (TRAViATA). J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
111
|
Taleb I, Wever-Pinzon O, Yin M, Kfoury A, Caine W, Stehlik J, Catino A, Wever-Pinzon J, Bonios M, McKellar S, Alharethi R, Koliopoulou A, Fang J, Selzman C, Dranow E, Shah P, Singh R, Psotka M, Zhu W, Slaughter M, Birks E, Koenig S, Kanwar M, Kyvernitakis A, Hoffman K, Guglin M, Kotter J, Campbell K, Drakos S. Predicting Cardiac Structural and Functional Improvement Induced by Mechanical Unloading in Chronic Heart Failure: A Derivation-Validation Multicenter Study. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
112
|
Doshi A, Tushak Z, Kong H, Garcia V, Jang M, Shah P, Hsu S, Feller E, Rodrigo M, Najjar S, Fideli U, Marishta A, Bhatti K, Yang Y, Tunc I, Solomon M, Berry G, Marboe C, Agbor-Enoh S, Shah K, Valantine H. Increased Cell Free DNA Levels in African American Patients Early after Heart Transplantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
113
|
Agbor-Enoh S, Ponor I, Shah P, Levine D, Cochrane A, Philogene M, Matthews J, Brown A, Timofte I, Fideli U, Kong H, Marishta A, Bhatti K, Tunc I, Yang Y, Luikart H, Marboe C, Berry G, Iacono A, Nathan S, Khush K, Orens J, Jang M, Valantine H. To Treat or Not to Treat: DSA Positive Lung Transplant Recipients. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
114
|
Bazemore K, Permpalung N, Rohly M, Timofte I, Brown A, Orens J, Iacono A, Nathan S, Avery R, Valentine H, Agbor-Enoh S, Shah P. Characterization of Respiratory Pathogens in Contemporary Lung Transplant Recipients. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
115
|
Philogene M, Massie A, Kong H, Shah P, Cochrane A, Ponor I, Levine D, Shah K, Hsu S, Feller E, Rodrigo M, Najjar S, Tunc I, Berry G, Marboe C, Jang M, Agbor-Enoh S, Valantine H. Association between Pretransplant Antibody against Angiotensin II Type 1 Receptor and Posttransplant Allograft Injury. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
116
|
Cantu E, Bermudez C, Cevasco M, Suzuki Y, Buckley T, Galati V, Majeti N, Benvenuto L, Anderson M, Wille K, Weinacker A, Dhillon G, Orens J, Shah P, Lama V, McDyer J, Snyder L, Palmer S, Hartwig M, Hage C, Singer J, Calfee C, Kukreja J, Greenland J, Ware L, Hsu J, Gallop R, Diamond J, Christie J. Implications of ECMO Bridging and Salvage Strategies on Mortality and PGD. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
117
|
Krishnan A, Bush E, Chidi A, Nolley E, Agbor-Enoh S, West N, Tallarico E, Orens J, Ha J, Shah P, Segev D, Massie A, Higgins R, Merlo C. The Effect of the Cystic Fibrosis Care Center on Lung Transplant Outcomes. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
118
|
Agbor-Enoh S, Jang M, Singh K, Tunc I, Pirooznia M, Seifuddin F, Ponor I, Levine D, Cochrane A, Philogene M, Mathews J, Shah P, Luikart H, Khush K, Marboe C, Berry G, Valantine H. Early and Late Pulmonary AMR Show Distinct Profiles; Clinical and Epigenetic Analyses. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
119
|
Cooper L, Cochrane A, Cherikh W, Toll A, Psotka M, Shah P, Lund L, Stehlik J, Mentz R, Zuckermann A. Induction Therapy after Heart Transplantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
120
|
PATEL U, Patel H, Darji P, Patwari D, Shah P, Mazumdar M, Mandowara B, Shah R, Chotai N. SAT-422 SPECTRUM OF ACUTE KIDNEY INJURY IN DENGUE FEVER. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
121
|
Kute V, patel H, Shah P. SUN-378 CLINICAL AND HISTOPATHOLOGIC PROFILE OF IGA NEPHROPATHY IN A TERTIARY HOSPITAL IN INDIA. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
122
|
MESHRAM H, Kute V, Shah P. SAT-357 EXPANDING DONOR POOL BY UTILISING DECEASED DONOR WITH SNAKE BITE. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
123
|
MAZUMDAR M, Mandowara B, Patil R, Darji P, Patel H, Shah P, Patwari D. SAT-433 RENAL CORTICAL NECROSIS IN NON-HEMORRHAGIC DENGUE FEVER- A RARE CASE REPORT. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
124
|
Abbott J, Shah P. Amblyopia, deprivation and health disparities research: challenges in 2020. Eye (Lond) 2020; 34:1491-1493. [PMID: 32094471 PMCID: PMC7609316 DOI: 10.1038/s41433-020-0823-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 11/09/2022] Open
|
125
|
Shah P, Iwata Y, Brown EE, Kim J, Sanches M, Takeuchi H, Nakajima S, Hahn M, Remington G, Gerretsen P, Graff-Guerrero A. Clozapine response trajectories and predictors of non-response in treatment-resistant schizophrenia: a chart review study. Eur Arch Psychiatry Clin Neurosci 2020; 270:11-22. [PMID: 31428862 DOI: 10.1007/s00406-019-01053-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/07/2019] [Indexed: 02/06/2023]
Abstract
Although clozapine is the main antipsychotic medication for treatment-resistant schizophrenia, 40-70% of patients on clozapine have persistent psychotic symptoms (i.e. ultra-treatment-resistant schizophrenia, UTRS). We aimed to examine clozapine response/non-response patterns in patients with treatment-resistant schizophrenia, as well as determine patient clinico-demographic factors associated with long-term clozapine non-response. Clinico-demographic characteristics of 241 patients on clozapine were collected through a retrospective chart review. The median (interquartile range, IQR) follow-up from illness onset was 25.0 (IQR = 24.0) years. Clozapine response was assessed at median 10.8 (IQR = 14.0) months (Time 1, T1) and 7.2 (IQR = 13.5) years (Time 2, T2) after its initiation. It was evaluated by chart reviewers based on the information provided in clinical notes. Binomial logistic regression was used to determine clinico-demographic factors associated with clozapine non-response at both T1 and T2 (i.e. stable UTRS, S-UTRS) compared to clozapine response at both times (i.e. stable clozapine responders, S-ClozResp). Among clozapine responders (n = 122) at T1, 83.6% remained clozapine responsive and 16.4% became non-responsive at T2. In the UTRS group (n = 119) at T1, 87.4% remained clozapine non-responsive and 12.6% became responsive at T2. Duration of delay in clozapine initiation (OR = 0.94, Wald χ2 = 5.33, p = 0.021) and number of pre-clozapine hospitalizations (OR = 0.95, Wald χ2 = 5.20, p = 0.023) were associated with S-UTRS. Most UTRS patients were non-responsive to clozapine from the start of treatment. Preventing delay in initiating clozapine and relapses could help promote long-term clozapine response in patients with treatment-resistant schizophrenia. Future longitudinal studies are required to explore the neuropathological correlates of relapses and delay in clozapine initiation.
Collapse
|