Clozapine vs the Rest for Treatment-Refractory Schizophrenia

Peter M. Yellowlees, MBBS, MD


February 24, 2017

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This is the Medscape Psychiatry Minute. I'm Dr Peter Yellowlees.

Clozapine is increasingly seen as the gold standard for treatment-refractory schizophrenia, although meta-analyses of clozapine for this condition are lacking. Now a team of investigators[1] from the University of Queensland, Australia, have conducted a systematic review and meta-analysis of clozapine treatment for people with treatment-refractory schizophrenia.

Twenty-one papers with 25 comparison treatments were included, and the researchers found that clozapine was superior for treating positive symptoms in both the short and long term. When used only in the short term, clozapine was superior for positive and negative symptoms, with higher baseline psychosis scores predicting better outcomes for clozapine.

This is an extremely important study for all psychiatrists to consider. Clozapine is relatively underutilized in patients who have schizophrenia in the United States, and other recent studies have suggested it should be the treatment of choice for all patients who have had a single failed trial of a different first- or second-generation antipsychotic. The authors of this meta-analysis concluded that clozapine is superior to other drug treatments for treatment-refractory schizophrenia, but that if there is no response by 6 months, medications with lower adverse reactions should then be considered.

The evidence on this topic is clear. If you are not prescribing clozapine in at least 6-month trials for your patients with treatment-refractory schizophrenia, you need to change your practice and start doing so.

Thank you for listening to this Medscape Psychiatry Minute. Do enjoy your practice.


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