Inflammatory markers in outpatients with schizophrenia diagnosis in regular use of clozapine: a cross-sectional study

Victor Hugo Schaly Cordova; Amelia Dias Teixeira; Ana Paula Anzolin; Roberta Moschetta; Paulo Silva Belmonte-de-Abreu

doi:10.3389/fpsyt.2023.1269322

Inflammatory markers in outpatients with schizophrenia diagnosis in regular use of clozapine: a cross-sectional study

Front Psychiatry. 2023 Oct 9:14:1269322. doi: 10.3389/fpsyt.2023.1269322. eCollection 2023.

Authors

Victor Hugo Schaly Cordova^{1

2}, Amelia Dias Teixeira¹, Ana Paula Anzolin^{3

4}, Roberta Moschetta⁵, Paulo Silva Belmonte-de-Abreu^{1

6}

Affiliations

¹ Faculty of Medicine, Graduate Program in Psychiatry and Behavior Science, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
² Clinical Hospital of Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
³ Institute of Basic Health Science, Graduate Program in Biological Science: Biohemestry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
⁴ Laboratory of Molecular Psychiatry, Clincal Hospital of Porto Alegre (HCPA), Porto Alegre, Brazil.
⁵ Faculty of Medicine Undergraduate Course in Medine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
⁶ Psychiatry Service, Clinical Hospital of Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.

Abstract

It is known that inflammation worsen the course of schizophrenia and induce high clozapine serum levels. However, no study evaluated this change in function of clozapine daily dose in schizophrenia. We assessed the correlation between inflammation and severity symptoms in patients with schizophrenia that take and do not take clozapine. We also assessed the correlation between clozapine daily dose and inflammatory markers to patients who take this drug. Patients were recruited from Schizophrenia Ambulatory and Psychosocial Care Center of Clinical Hospital of Porto Alegre and from an association of relatives of patients with schizophrenia. Exam results, and other important clinical exam were assessed in patients record or patients were asked to show their exam in the case of outpatients. We included 104 patients, 90 clozapine users and 14 non-clozapine users. We calculate the systemic inflammatory markers [neutrophil-lymphocyte ratio (NLR), systemic immune inflammation index (SII), and the psychopathology severity by the Brief Psychiatric Rating Scaled anchored (BPRS-a)]. These variables were compared between clozapine users and non-clozapine users. It was used mean/median test according to data distributing, with study factor (SII, MLR, and PLR), the clinical outcome: severity of symptomatology (BPRS score), and clozapine daily dose as adjustment factor. Clozapine users exhibited a significantly higher neutrophil count (mean ± SD: 5.03 ± 2.07) compared to non-clozapine users (mean ± SD: 3.48 ± 1.27; p = 0.031). After controlling for comorbidity, other parameters also showed significant differences. These findings are consistent with previous studies that have demonstrated an inflammatory response following the administration of clozapine.

Keywords: immunoinflammatory systemic index; inflammatory markers; inflammatory response; neutrophil-linphocyte ratio; psychopharmacology; second generation antipsychotic.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was financied by FIPE, Clinical Hospital of Porto Alegre. Brazilian Federal Agency for Support and Evaluation of Graduate Education. None of which had more participation in the study design, collection, analysis, or interpretation of data, in writing the report, or in decision to submit the work for publication.