Continuous clozapine treatment in schizophrenia was associated with lower long-term all-cause mortality compared to other antipsychotics (rate ratio 0.56; 95% CI 0.36-0.85; P=0.007).
Meta-Analysis
Does continuous clozapine treatment reduce long-term all-cause mortality in adults with schizophrenia-spectrum disorders compared to other antipsychotics?
Continuous clozapine treatment in schizophrenia patients is associated with a significantly lower long-term all-cause mortality rate compared to other antipsychotics.
Relative Risk: 0.56 (95% CI 0.36–0.85)
p-value: p=.007
INTRODUCTION: Patients with schizophrenia have an elevated mortality risk compared to the general population, with cardiovascular-related deaths being the leading cause. The role of clozapine use in the long-term mortality risk is unclear. While clozapine treatment may increase the risk for cardiovascular mortality, it may have protective effects regarding suicidal behavior. METHODS: We systematically searched EMBASE, MEDLINE, and PsycINFO and reviewed studies that used a long-term follow-up (ie, >52 weeks) and reported on mortality in adults diagnosed with schizophrenia-spectrum disorders who had received clozapine treatment. RESULTS: Altogether, 24 studies reported on 1327 deaths from any causes during 217691 patient years in patients treated with clozapine. The unadjusted mortality rate in 22 unique samples during a follow-up of 1.1-12.5 (median = 5.4) years was 6.7 (95% confidence interval CI = 5.4-7.9) per 1000 patient years. Long-term, crude mortality rate ratios were not significantly lower in patients ever treated with clozapine during follow-up, but significantly lower in patients continuously treated with clozapine compared to patients with other antipsychotics (mortality rate ratio = 0.56, 95% CI = 0.36-0.85, P-value = .007). Few studies reported on rates of long-term cause-specific mortality (suicide and ischemic heart disease), which showed no significant difference in patients using clozapine compared to patients using other antipsychotics. Statistical heterogeneity was high in all analyses. DISCUSSION: Continuous clozapine treatment in schizophrenia patients was associated with a significantly lower long-term all-cause mortality rate compared to other antipsychotic use. These findings, combined with the known efficacy of clozapine, give reason to re-evaluate the hesitancy to prescribe clozapine in regular care settings. TRIAL REGISTRATION: PROSPERO CRD42017069390.
Vermeulen et al. (Thu,) conducted a meta-analysis in Schizophrenia-spectrum disorders. Clozapine vs. Other antipsychotics was evaluated on Long-term all-cause mortality (mortality rate ratio 0.56, 95% CI 0.36-0.85, p=.007). Continuous clozapine treatment in schizophrenia was associated with lower long-term all-cause mortality compared to other antipsychotics (rate ratio 0.56; 95% CI 0.36-0.85; P=0.007).
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