Clozapine and Neutropenia in Patients with Schizophrenia and SARS-CoV-2 Infection

Silvia Moga; Andreea Teodorescu; Petru Ifteni; Paula-Simina Petric; Ana-Aliana Miron

doi:10.2147/NDT.S361405

Clozapine and Neutropenia in Patients with Schizophrenia and SARS-CoV-2 Infection

Neuropsychiatr Dis Treat. 2022 May 4:18:977-983. doi: 10.2147/NDT.S361405. eCollection 2022.

Authors

Silvia Moga^{1

2}, Andreea Teodorescu^{1

2}, Petru Ifteni^{1

2}, Paula-Simina Petric^{1

2}, Ana-Aliana Miron^{1

2}

Affiliations

¹ Transilvania University of Brasov, Brasov, Romania.
² Spitalul Clinic de Psihiatrie si Neurologie Brasov, Brasov, Romania.

Abstract

Background: Clozapine (CLZ) is used for treatment-resistant schizophrenia (TRS). Adverse reactions to clozapine include neutropenia. In March 2020, WHO declared the COVID-19 pandemic and after, psychiatrists raised concerns regarding continuation of clozapine, due to multiple restrictions. We aimed to provide a study on the association between neutropenia and clozapine in patients with schizophrenia and COVID-19.

Aim: To assess the neutrophil count in patients with schizophrenia treated with clozapine and infected with COVID-19.

Methods: The study patients with schizophrenia, according to DSM-5, admitted to the Clinical Hospital of Psychiatry and Neurology Brasov, Romania, between April 2020 and October 2021. The inclusion criteria included positive RT-PCR (real-time PCR) test for COVID-19 and treatment with clozapine. We assessed three values of ANC (absolute neutrophil count): before COVID-19 infection (last ANC obtained at mandatory check), during infection and 1 month after resolution (first negative PCR test).

Results: Of the 105 cases, 95 did not have neutropenia. Fifty-nine patients were males (62.1%), mean age was 43.5 years (SD = 12.1) with an average of clozapine treatment of 52.4 months (SD = 11.9). At baseline, they had a small reduction in the ANC mean value (4.41 × 109/l; SD = 2.22) which did not constitute a statistically significant decline from the prior to COVID-19 mean value of 4.66 × 109/l (SD = 2.34; p = 0.45). Values were also normal in the first month after negative PCR testing (4.45 × 109/l; SD = 2.35; p = 0.91). A total of 10 patients (9.5%) had neutropenia. The age, dose of clozapine and duration of treatment were not statistically different compared to the group without neutropenia.

Conclusion: Psychiatrists and other health professionals should keep in mind that neutrophil count may decrease during COVID-19 infection in patients taking clozapine and in some cases, neutropenia may even occur. We assumed that neutropenia could be caused by COVID-19 and clozapine interaction.

Keywords: SARS-CoV-2; agranulocytosis; clozapine; neutropenia; schizophrenia.