Influence of time to clozapine prescription on the clinical outcome

Leticia I Muñoz-Manchado; Jose I Perez-Revuelta; Arka Banerjee; Liliana Galindo-Guarin; Miguel Bernardo; Francisco González-Saiz; J M Villagrán-Moreno; Emilio Fernández-Egea

doi:10.1016/j.schres.2023.09.028

Influence of time to clozapine prescription on the clinical outcome

Schizophr Res. 2023 Oct 6:S0920-9964(23)00339-0. doi: 10.1016/j.schres.2023.09.028. Online ahead of print.

Authors

Leticia I Muñoz-Manchado¹, Jose I Perez-Revuelta², Arka Banerjee³, Liliana Galindo-Guarin⁴, Miguel Bernardo⁵, Francisco González-Saiz⁶, J M Villagrán-Moreno⁷, Emilio Fernández-Egea⁸

Affiliations

¹ Department of Psychiatry, Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom; Unidad de Gestión clínica de Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital Universitario de Jerez de la Frontera, Severe Mental Disorder Research Group, Department of Neuroscience, University of Cádiz, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain. Electronic address: leticia.munoz.sspa@juntadeandalucia.es.
² Unidad de Gestión clínica de Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital Universitario de Jerez de la Frontera, Severe Mental Disorder Research Group, Department of Neuroscience, University of Cádiz, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain. Electronic address: jose.perezrevuelta@uca.es.
³ St George's University Hospitals NHS Foundation Trust, London, United Kingdom. Electronic address: ab2458@cantab.ac.uk.
⁴ Department of Psychiatry, Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom. Electronic address: liliana.galindoguarin@cpft.nhs.uk.
⁵ Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Barcelona Clinic Schizophrenia Unit, Hospital Clínic de Barcelona, Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 170, Villarroel St., 8037 Barcelona, Spain. Electronic address: bernardo@clinic.cat.
⁶ Unidad de Gestión clínica de Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital Universitario de Jerez de la Frontera, Severe Mental Disorder Research Group, Department of Neuroscience, University of Cádiz, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain. Electronic address: franciscomanuel.gonzalez@uca.es.
⁷ Unidad de Gestión clínica de Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Hospital Universitario de Jerez de la Frontera, Severe Mental Disorder Research Group, Department of Neuroscience, University of Cádiz, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain. Electronic address: jmaria.villagran.sspa@juntadeandalucia.es.
⁸ Department of Psychiatry, Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom. Electronic address: ef280@cam.ac.uk.

PMID: 37805277
DOI: 10.1016/j.schres.2023.09.028

Abstract

Background: This study investigates whether early clozapine use is associated with improved responses in different clinical domains, including positive and negative symptoms, functioning, and well-being.

Methods: Data from 254 clozapine-treated patients at Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) were analysed. Among them, 231 (90.9 %) had a diagnosis of schizophrenia, 21 (8.3 %) schizoaffective disorder, and 2 (0.8 %) had other diagnoses. The International Classification of Diseases-Mortality and Morbidity Statistics criteria (ICD-10) were employed (World Health Organization, 1992). The cohort was assessed using the positive and negative syndrome scale (PANSS), the Brief Negative Symptom Scale (BNSS), Global Assessment of Functioning Scale (GAF), and the short version of Warwick-Edinburgh Mental Well-being Scale (SWEMWBS). Logistic regression models (for positive and negative symptom remission) and linear regression (for functioning and well-being) were utilized to assess the influence of time to clozapine initiation (TCI), age at the first episode of psychosis (AFE), duration of clozapine treatment (DCT), and gender.

Results: Early clozapine treatment (within the first three years after the first episode of psychosis) was associated with increased negative symptom remission (exp (B) = 0.38; p = 0.02) and higher functioning scores (β = -0.12, p = 0.046). However, no effect of time to clozapine initiation was found on positive symptom remission rates or well-being scores.

Conclusions: Initiating clozapine treatment within the first 3 years of the first episode of psychosis may lead to reduced severity of negative symptoms and improved functioning in clozapine-treated patients. The time to clozapine initiation did not influence its effect on positive symptom remission rates.

Keywords: Delay; Duration of psychosis; Negative symptoms; Remission; Treatment-resistant schizophrenia.