Clozapin in der Behandlung schizophrener Psychosen Patientencharakteristika und antipsychotische Kombinationstherapien bei einem Behandlungsjahrgang eines psychiatrischen Versorgungskrankenhauses

Zusammenfassung

Anliegen Clozapin zeigt in vielen Untersuchungen eine überlegene Wirksamkeit gegenüber anderen Antipsychotika. Zur Verschreibungspraxis von Clozapin und den Charakteristika der damit behandelten Patienten gibt es bislang wenig systematisch erhobene Daten.

Methode Retrospektive Auswertung aller 392 Behandlungsverläufe von stationär behandelten Patienten mit schizophrenen Psychosen eines Jahres. Detaillierte Analyse der mit Clozapin behandelten Patienten einschließlich der Dosierungen und der zusätzlichen Medikation.

Ergebnis Patienten mit Clozapinbehandlung weisen eine höhere Krankheitsschwere als Patienten ohne Clozapinbehandlung auf. Sie erhalten häufiger pharmakologische Kombinationsbehandlungen, die den gegenwärtigen Leitlinienempfehlungen teilweise erheblich entgegenstehen.

Schlussfolgerung Die Ergebnisse unterstreichen die ausgeprägte Krankheitsschwere von Patienten mit einer Clozapinbehandlung und belegen Hinweise aus der Literatur auf die begrenzte Umsetzung von Leitlinien in die Verschreibungspraxis. Die durchgeführte Untersuchung dient als Pilotuntersuchung einer multizentrischen Studie zur Verschreibungspraxis von Clozapin in psychiatrischen Kliniken unterschiedlicher Regionen.

Abstract

Background In many studies, clozapine has been reported to have superior effectiveness compared to other antipsychotics. So far there is little systematic data on the practice of clozapine prescription and characteristics of patients treated.

Method Retrospective evaluation of all 392 treatment courses of inpatients with schizophrenic psychoses during one year. Detailed analysis of the patients treated with clozapine including the dosages and additional psychotropic medication.

Result Patients treated with clozapine showed a higher disease severity than patients without clozapine. They received more frequently pharmacological combination therapies, which in some cases significantly contradicted the current guideline recommendations.

Conclusion The results underline the pronounced disease severity of patients receiving clozapine treatment and substantiate evidence from the literature on the limited implementation of guidelines in prescribing practice. The study carried out serves as a pilot survey of a multicenter research project on the practice of prescribing clozapine in psychiatric hospitals in different German regions.

Schlüsselwörter

Clozapin - Antipsychotische Kombination - Schizophrenie - Antipsychotische - Monotherapie

Keywords

Clozapine - Antipsychotic combination - Schizophrenia - Antipsychotic - monotherapy

Publication History

Received: 17 March 2021

Accepted: 07 June 2021

Article published online:
12 August 2021

• Literatur

• 1 DGPPN. S3-Leitlinie Schizophrenie. Langfassung, Version 1.0. verfügbar unter https://wwwawmforg/leitlinien/detail/II/038-009html 2019
• 2 National Collaborating Centre for Mental H. National Institute for Health and Clinical Excellence: Guidance. In Schizophrenia: Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care (Update). Leicester (UK): British Psychological Society, Copyright © 2009, National Collaborating Centre for Mental Health; 2009
• 3 Huhn M, Nikolakopoulou A, Schneider-Thoma J. et al. Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis. Lancet (London, England) 2019; 394: 939-951. DOI: 10.1016/s0140-6736(19)31135-3.
• 4 van der Zalm YC, Termorshuizen F, Schulte PF. et al. Prescription and Underprescription of Clozapine in Dutch Ambulatory Care. Frontiers in psychiatry 2018; 9: 231 DOI: 10.3389/fpsyt.2018.00231.
• 5 Brieden T, Ujeyl M, Naber D. Psychopharmacological treatment of aggression in schizophrenic patients. Pharmacopsychiatry 2002; 35: 83-89. DOI: 10.1055/s-2002-31523.
• 6 Zalsman G, Hawton K, Wasserman D. et al. Suicide prevention strategies revisited: 10-year systematic review. The lancet Psychiatry 2016; 3: 646-659. DOI: 10.1016/s2215-0366(16)30030-x.
• 7 Naber D, Holzbach R, Perro C. et al. Clinical management of clozapine patients in relation to efficacy and side-effects. The British journal of psychiatry Supplement 1992: 54–59
• 8 Naber D, Hippius H. The European experience with use of clozapine. Hospital & community psychiatry 1990; 41: 886-890. DOI: 10.1176/ps.41.8.886.
• 9 PSIAC. Interaktionsdatenbank für Ärzte und Apotheker © 2020 Springer Nature Switzerland AG htpps://www psiac de Datenbankabfrage vom 29.12.20
• 10 GmbH AIfaQiG. Sektorenübergreifende Qualitätssicherung im Gesundheitswesen nach §137a SGB V: Versorgung von volljährigen Patienten und Patientinnen mit Schizophrenie, schizotypen und wahnhaften Störungen. Abschlussbericht. 2016
• 11 Khokhar JY, Henricks AM, Sullivan EDK. et al. Unique Effects of Clozapine: A Pharmacological Perspective. Advances in pharmacology (San Diego, Calif) 2018; 82: 137-162. DOI: 10.1016/bs.apha.2017.09.009.
• 12 Schmidt-Kraepelin C, Puschner B, Loos S. et al. Antipsychotische Polypharmazie bei Patienten mit Schizophrenie und hoher Versorgungsinanspruchnahme. Psychiatrische Praxis 2013; 40: 380-384 DOI: 10.1055/s-0033-1343185.
• 13 Gallego JA, Bonetti J, Zhang J. et al. Prevalence and correlates of antipsychotic polypharmacy: a systematic review and meta-regression of global and regional trends from the 1970s to 2009. Schizophrenia research 2012; 138: 18-28. DOI: 10.1016/j.schres.2012.03.018.
• 14 Correll CU, Rubio JM, Inczedy-Farkas G. et al. Efficacy of 42 Pharmacologic Cotreatment Strategies Added to Antipsychotic Monotherapy in Schizophrenia: Systematic Overview and Quality Appraisal of the Meta-analytic Evidence. JAMA psychiatry 2017; 74: 675-684 DOI: 10.1001/jamapsychiatry.2017.0624.
• 15 Kuipers E, Yesufu-Udechuku A, Taylor C. et al. Management of psychosis and schizophrenia in adults: summary of updated NICE guidance. BMJ (Clinical research ed) 2014; 348: g1173 DOI: 10.1136/bmj.g1173.
• 16 Correll CU, Shaikh L, Gallego JA. et al. Antipsychotic polypharmacy: a survey study of prescriber attitudes, knowledge and behavior. Schizophrenia research 2011; 131: 58-62 DOI: 10.1016/j.schres.2011.02.016.
• 17 Guinart D, Correll CU. Antipsychotic Polypharmacy in Schizophrenia: Why Not?. The Journal of clinical psychiatry 2020; 81 DOI: 10.4088/JCP.19ac13118.
• 18 Schmidt-Kraepelin C, Meisenzahl-Lechner E, Kujovic M. et al. Antipsychotische Polypharmazie in der Behandlung von Patientinnen und Patienten mit Schizophrenie am Beispiel von neun psychiatrischen Fachkliniken des Landschaftsverbandes Rheinland. Psychiatrische Praxis 2021; doi:10.1055/a-1321-7866.
• 19 Galling B, Roldán A, Hagi K. et al. Antipsychotic augmentation vs. monotherapy in schizophrenia: systematic review, meta-analysis and meta-regression analysis. World psychiatry: official journal of the World Psychiatric Association (WPA) 2017; 16: 77-89 DOI: 10.1002/wps.20387.
• 20 Barnes T, Leeson V, Paton C. et al. SU11. Amisulpride Augmentation of Clozapine for Treatment-Refractory Schizophrenia: The AMICUS Study. Schizophrenia bulletin 2017; 43: S164-S165. DOI: 10.1093/schbul/sbx024.010.
• 21 Fleischhacker WW, Heikkinen ME, Olié JP. et al. Effects of adjunctive treatment with aripiprazole on body weight and clinical efficacy in schizophrenia patients treated with clozapine: a randomized, double-blind, placebo-controlled trial. The international journal of neuropsychopharmacology 2010; 13: 1115-1125. DOI: 10.1017/s1461145710000490.
• 22 Tiihonen J, Taipale H, Mehtälä J. et al. Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia. JAMA psychiatry 2019; 76: 499-507 DOI: 10.1001/jamapsychiatry.2018.4320.
• 23 Nguyen T, Seiler N, Brown E. et al. The effect of Clinical Practice Guidelines on prescribing practice in mental health: A systematic review. Psychiatry research 2020; 284: 112671 DOI: 10.1016/j.psychres.2019.112671.
• 24 Rajkumar AP, Poonkuzhali B, Kuruvilla A. et al. Outcome definitions and clinical predictors influence pharmacogenetic associations between HTR3A gene polymorphisms and response to clozapine in patients with schizophrenia. Psychopharmacology 2012; 224: 441-449. DOI: 10.1007/s00213-012-2773-2.
• 25 Okhuijsen-Pfeifer C, Huijsman EAH, Hasan A. et al. Clozapine as a first- or second-line treatment in schizophrenia: a systematic review and meta-analysis. Acta psychiatrica Scandinavica 2018; 138: 281-288 DOI: 10.1111/acps.12954.
• 26 Caliskan AM, Karaaslan M, Inanli I. et al. The effects of adding long-acting injectable antipsychotic drugs to clozapine on relapse and hospitalization in patients with treatment-resistant schizophrenia: a mirror-image retrospective study. International clinical psychopharmacology 2021; 36: 30-33. DOI: 10.1097/yic.0000000000000336.
• 27 Grimminck R, Oluboka O, Sihota M. et al. Combination of Clozapine With Long-Acting Injectable Antipsychotics in Treatment-Resistant Schizophrenia: Preliminary Evidence From Health Care Utilization Indices. Prim Care Companion CNS Disord 2020; 22. doi:10.4088/PCC.19m02560
• 28 Jann MW, Grimsley SR, Gray EC. et al. Pharmacokinetics and pharmacodynamics of clozapine. Clinical pharmacokinetics 1993; 24: 161-176. DOI: 10.2165/00003088-199324020-00005.
• 29 Azorin JM, Simon N. Antipsychotic polypharmacy in schizophrenia: evolving evidence and rationale. Expert Opin Drug Metab Toxicol 2020; 16: 1175-1186. DOI: 10.1080/17425255.2020.1821646.
• 30 Hasan A. https://geprisdfgde/gepris/projekt/316096538?context=projekt&task=showDetail&id=316096538& Hasan A. Effektivtät einer frühzeitigen Applikation von Clozapin auf die Remissionraten bei der akuten Schizophrenie (EARLY-Studie). https://geprisdfgde/gepris/projekt/316096538?context=projekt&task=showDetail&id=316096538& Aktuelle Studie