Study may prompt rethink on clozapine restrictions

Finnish researchers have called for a reassessment of restrictions on the use of clozapine after their population study found that it was associated with a substantially lower mortality risk than any other antipsychotic. The 11 year study found that long-term treatments with antipsychotics were associated with lower mortality compared with no antipsychotic use, and that second-generation antipsychotics were “highly heterogeneous” in their mortality effects. Chair of the Royal Australian and New Zealand College of Psychiatrists committee for research associate professor Mal Hopwood told Psychiatry Update that the finding was “exciting” news. “Certainly I don’t think it removes the need to do cardiovascular monitoring in patients on atypical antipsychotics but I hope the research will make clinicians feel confident to make the move to clozapine earlier in treatment resistant patients,” he added. The researchers used nation-wide registers to compare the cause-specific mortality of nearly 67 000 patients with schizophrenia with the rest of the Finnish population. They found that, despite the fact that the proportional use of second-generation antipsychotics had increased from 13% to 64% between 1996 and 2006, there was no widening of the mortality gap between people with schizophrenia and the general population (25 vs 22.5 years). Compared with current use of perphenazine, the highest risk for overall mortality was recorded for quetiapine (adjusted HR 1.41), and the lowest risk for clozapine (HR 0.74, p=0.0045). “Our results raise the issue of whether clozapine should be used as a first-line treatment, because it seems to be the safest antipsychotic in terms of mortality and it is also the most effective,” the researchers said. The Lancet, early online publication....