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Corbeil O, Béchard L, Fournier É, Plante M, Thivierge MA, Lafrenière CÉ, Huot-Lavoie M, Brodeur S, Essiambre AM, Roy MA, Demers MF. Clozapine rechallenge or continuation despite neutropenia or agranulocytosis using colony-stimulating factor: A systematic review. J Psychopharmacol 2023; 37:370-377. [PMID: 36794520 PMCID: PMC10363950 DOI: 10.1177/02698811231154111] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVES Rechallenge/continuation of clozapine in association with colony-stimulating factors (CSFs) following neutropenia/agranulocytosis has been reported, but many questions remain unanswered about efficacy and safety. This systematic review aims to assess the efficacy and safety of rechallenging/continuing clozapine in patients following neutropenia/agranulocytosis using CSFs. METHODS MEDLINE, Embase, PsycInfo, and Web of Science databases were searched from inception date to July 31, 2022. Articles screening and data extraction were realized independently by two reviewers, according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 systematic review guidance. Included articles had to report on at least one case where clozapine was rechallenged/continued using CSFs despite previous neutropenia/agranulocytosis. RESULTS Eight hundred forty articles were retrieved; 34 articles met the inclusion criteria, totaling 59 individual cases. Clozapine was successfully rechallenged/continued in 76% of patients for an average follow-up period of 1.9 years. There was a trend toward better efficacy reported in case reports/series, compared with consecutive case series (overall success rates of 84% and 60%, respectively, p-value = 0.065). Two administration strategies were identified, "as-needed" and prophylactic, both yielding similar success rates (81% and 80%, respectively). Only mild and transient adverse events were documented. CONCLUSIONS Although limited by the relatively small number of published cases, factors such as time of onset to first neutropenia and severity of the episode did not seem to impact the outcome of a subsequent clozapine rechallenge using CSFs. While the efficacy of this strategy remains to be further adequately evaluated in more rigorous study designs, its long-term innocuity warrants considering its use more proactively in the management of clozapine hematological adverse events as to maintain this treatment for as many individuals as possible.
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Affiliation(s)
- Olivier Corbeil
- Faculty of Pharmacy, Université Laval, Québec City, QC, Canada.,Institut Universitaire en Santé Mentale de Québec, Québec City, QC, Canada.,CERVO Brain Research Centre, Québec City, QC, Canada
| | - Laurent Béchard
- Faculty of Pharmacy, Université Laval, Québec City, QC, Canada.,Institut Universitaire en Santé Mentale de Québec, Québec City, QC, Canada.,CERVO Brain Research Centre, Québec City, QC, Canada
| | - Émilien Fournier
- Faculty of Pharmacy, Université Laval, Québec City, QC, Canada.,CERVO Brain Research Centre, Québec City, QC, Canada
| | - Maude Plante
- Faculty of Pharmacy, Université Laval, Québec City, QC, Canada.,Institut Universitaire en Santé Mentale de Québec, Québec City, QC, Canada
| | - Marc-André Thivierge
- Faculty of Pharmacy, Université Laval, Québec City, QC, Canada.,Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Maxime Huot-Lavoie
- CERVO Brain Research Centre, Québec City, QC, Canada.,Faculty of Medicine, Université Laval, Québec City, QC, Canada
| | - Sébastien Brodeur
- Institut Universitaire en Santé Mentale de Québec, Québec City, QC, Canada.,CERVO Brain Research Centre, Québec City, QC, Canada.,Faculty of Medicine, Université Laval, Québec City, QC, Canada
| | - Anne-Marie Essiambre
- CERVO Brain Research Centre, Québec City, QC, Canada.,School of Psychology, Faculty of Social Sciences, Université Laval, Québec City, QC, Canada
| | - Marc-André Roy
- Institut Universitaire en Santé Mentale de Québec, Québec City, QC, Canada.,CERVO Brain Research Centre, Québec City, QC, Canada.,Faculty of Medicine, Université Laval, Québec City, QC, Canada
| | - Marie-France Demers
- Faculty of Pharmacy, Université Laval, Québec City, QC, Canada.,Institut Universitaire en Santé Mentale de Québec, Québec City, QC, Canada.,CERVO Brain Research Centre, Québec City, QC, Canada
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