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Rubio JM, Kane JM, Tanskanen A, Tiihonen J, Taipale H. Long-term persistence of the risk of agranulocytosis with clozapine compared with other antipsychotics: a nationwide cohort and case-control study in Finland. Lancet Psychiatry 2024; 11:443-450. [PMID: 38697177 DOI: 10.1016/s2215-0366(24)00097-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/09/2024] [Accepted: 03/13/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND Agranulocytosis is a life-threatening side-effect of clozapine, the only approved drug for treatment-resistant schizophrenia. The long-term profile of this complication has not yet been well established. Here we aim to describe the risk of clozapine-induced agranulocytosis over the long term. METHODS We used the entire population of Finland to identify people diagnosed with schizophrenia or schizoaffective disorder between 1972 and 2014 and developed a Kaplan-Meier model of time to diagnosis of agranulocytosis during clozapine versus non-clozapine treatment over a 22-year observation period (1996 to 2017). Next, we developed a nested case-control model for agranulocytosis matching by sex, age, time since diagnosis, and being in the incident cohort on a 1 to 5 ratio. Various durations of use for clozapine and non-clozapine antipsychotic treatment were compared to the modal antipsychotic use duration, deriving adjusted odds ratios (aORs) in a multivariable regression model. Recurrence and lethality rates for clozapine-induced agranulocytosis were described. These data reflect on all individuals with lived experience of schizophrenia in Finland during the study time, although individuals with lived experience were not included in the design of the study. FINDINGS We identified 61 769 people with schizophrenia or schizoaffective disorder (14 037 individuals treated with clozapine and 47 732 individuals treated with non-clozapine antipsychotics), with a mean age of 46·67 years (IQR 34·44-57·61), of whom 30 721 (49·7%) were female and 31 048 (50·3%) were male (data on ethnicity not available). Among those, 398 individuals were diagnosed with agranulocytosis (231 individuals treated with clozapine and 167 individuals treated with non-clozapine antipsychotics), representing a cumulative incidence of agranulocytosis for 1·37% (95% CI 0·58-3·16) on clozapine and 0·13% (0·04-0·23) on non-clozapine antipsychotics. In the case (n=398) versus control (n=1987) model, the risk of clozapine-induced agranulocytosis decreased steeply over time from an aOR of 36·01 (95% CI 16·79-77·22) for less than 6 months on clozapine to 4·38 (1·86-10·34) for clozapine use of 54 months or more. Only one of 3559 individuals starting clozapine died because of clozapine-induced agranulocytosis. INTERPRETATION The risk of clozapine-induced agranulocytosis decreases steeply over time but might be persistently greater than that of non-clozapine antipsychotics. This long-term risk excess seems small in absolute terms compared with the known magnitude of the advantages of clozapine in relevant outcomes, including life expectancy. Given the widespread underuse of clozapine, relaxing the long-term neutrophil monitoring could favour the advantages of long-term clozapine use, including greater life expectancy, without incurring the intolerable risk of clozapine-induced agranulocytosis. FUNDING Northwell Health and Sigrid Jusèlius Foundation.
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Affiliation(s)
- Jose M Rubio
- Northwell Health, New Hyde Park, NY, USA; Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, USA; Institute of Behavioral Science, Feinstein Institutes of Medical Research, Manhasset, NY, USA.
| | - John M Kane
- Northwell Health, New Hyde Park, NY, USA; Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, USA; Institute of Behavioral Science, Feinstein Institutes of Medical Research, Manhasset, NY, USA
| | - Antti Tanskanen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Jari Tiihonen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
| | - Heidi Taipale
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Plym A, Madueke I, Naik S, Isabelle M, Conti DV, Haiman CA, Penney KL, Mucci LA, Khorasani R, Kibel AS. Combining magnetic resonance imaging with a multi-ancestry polygenic risk score to improve identification of clinically significant prostate cancer. JNCI Cancer Spectr 2024; 8:pkae014. [PMID: 38429995 PMCID: PMC10980589 DOI: 10.1093/jncics/pkae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/06/2024] [Accepted: 02/26/2024] [Indexed: 03/03/2024] Open
Abstract
Multi-parametric magnetic resonance imaging (mpMRI) has emerged as an important tool for identifying clinically significant prostate cancer. We examined if the addition of a 400-variant multi-ancestry polygenic risk score (PRS) to mpMRI has the potential to improve identification. Based on data from 24 617 men from the Mass General Brigham Biobank, we identified 1243 men who underwent mpMRI. Men in the top PRS quartile were more likely to have clinically significant prostate cancer (47.1% vs 28.6% in the bottom PRS quartile, adjusted relative proportion 1.72 [95% CI = 1.35 to 2.19]). Both among men with a positive and a negative mpMRI, men in the top PRS quartile had the highest frequency of clinically significant cancer. In a constructed scenario for selecting men to undergo biopsy, use of the PRS lowered the frequency of missed clinically significant cancers from 9.1% to 5.9%. Our study provides initial support for using the PRS to improve identification of potentially lethal prostate cancer.
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Affiliation(s)
- Anna Plym
- Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ikenna Madueke
- Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sachin Naik
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark Isabelle
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - David V Conti
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Christopher A Haiman
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kathryn L Penney
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lorelei A Mucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rhamin Khorasani
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Adam S Kibel
- Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Han S, Zhang F, Yu H, Wei J, Xue L, Duan Z, Niu Z. Systemic inflammation accelerates the adverse effects of air pollution on metabolic syndrome: Findings from the China health and Retirement Longitudinal Study (CHARLS). ENVIRONMENTAL RESEARCH 2022; 215:114340. [PMID: 36108720 DOI: 10.1016/j.envres.2022.114340] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 09/08/2022] [Accepted: 09/10/2022] [Indexed: 06/15/2023]
Abstract
Long-term exposure to air pollution and systemic inflammation are associated with increased prevalence of metabolic syndrome (MetS); however, their joint effects in Chinese middle-aged and older adults is unknown. In this cross-sectional study, 11,838 residents aged 45 years and older from the China Health and Retirement Longitudinal Study (CHARLS) Wave 3 in 2015 were included. MetS was diagnosed using the Joint Interim Societies' definition. C-Reactive Protein (CRP) was assessed to reflect systemic inflammation. Individual exposure to air pollutants (particulate matter with a diameter ≤2.5 μm (PM2.5) or ≤ 10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), and carbon monoxide (CO)) was evaluated using satellite-based spatiotemporal models according to participant residence at county-level. Generalized linear models (GLMs) were applied to examine the association between air pollution and MetS, and the modification effects of CRP between air pollution and MetS were estimated using interaction terms of CRP and air pollutants in the GLM models. The prevalence of MetS was 32.37%. The adjusted odd ratio (OR) of MetS was 1.192 (95% confidence interval (CI): 1.116, 1.272), 1.177 (95% CI: 1.103, 1.255), 1.158 (95% CI: 1.072, 1.252), 1.303 (95% CI: 1.211,1.403), 1.107 (95% CI: 1.046, 1.171) and 1.156 (95% CI:1.083, 1.234), per inter-quartile range increase in PM2.5 (24.04 μg/m3), PM10 (39.00 μg/m3), SO2 (19.05 μg/m3), NO2 (11.28 μg/m3), O3 (9.51 μg/m3) and CO (0.46 mg/m3), respectively. CRP was also associated with increased prevalence of MetS (OR = 1.049, 95% CI: 1.035, 1.064; per 1.90 mg/L increase in CRP). Interaction analysis suggested that high CRP levels enhanced the association between air pollution exposure and MetS. Long-term exposure to air pollution is associated with increased prevalence of MetS, which might be enhanced by systemic inflammation. Given the rapidly aging society and heavy burden of MetS, measures should be taken to improve air quality and reduce systemic inflammation.
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Affiliation(s)
- Shichao Han
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, 127 West Changle Road, Xi'an, 710032, China
| | - Fen Zhang
- Departments of Hepatobiliary Surgery, Xijing Hospital, The Fourth Military Medical University, 127 West Changle Road, Xi'an, 710032, China
| | - Hongmei Yu
- Pukou District Center for Disease Control and Prevention, 120 Puyun Road, Nanjing, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, USA
| | - Lina Xue
- Department of Medical Affairs, Tangdu Hospital, The Fourth Military Medical University, 1 Xinsi Road, Xi'an, China
| | - Zhizhou Duan
- Preventive Health Service, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, 152 Aiguo Road, Nanchang, Jiangxi, China.
| | - Zhiping Niu
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, 127 West Changle Road, Xi'an, 710032, China.
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