ArticleClinical drug investigation2014
Pathway to clozapine use: a comparison between a patient cohort from New Zealand and a cohort from the United Kingdom.
Article in Clinical drug investigation, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 22 citations in OpenAlex.
- Clozapine prescribing in treatment-resistant schizophrenia - an updated systematic literature review of barriers and facilitators among clinicians.European journal of clinical pharmacology · 2026Pooled it
- Global trends in clozapine utilisation between 2014 and 2024: a longitudinal epidemiological study with data from 75 countries.The Lancet regional health. Europe · 2026Article
- Non-prescribing of clozapine for outpatients with schizophrenia in real-world settings: The clinicians' perspectives.Schizophrenia (Heidelberg, Germany) · 2023Article
- Characterization of antipsychotic utilization before clozapine initiation for individuals with schizophrenia: an innovative visualization of trajectories using French National Health Insurance data.Epidemiology and psychiatric sciences · 2023Article
- Design, development, and evaluation of the Maternal Outcomes and Nutrition Tool (MONT).Maternal & child nutrition · 2019Article
- Delayed Initiation of Clozapine Continues to Be a Substantial Clinical Concern.Canadian journal of psychiatry. Revue canadienne de psychiatrie · 2018Review
- Antipsychotic prescribing for vulnerable populations: a clinical audit at an acute Australian mental health unit at two-time points.BMC psychiatry · 2017Article
- Correlates of Clozapine Use after a First Episode of Schizophrenia: Results From a Long-term Prospective Study.CNS drugs · 2016Article
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
objectiveClozapine has been available since the early 1990s. Studies continue to demonstrate its superior efficacy in treatment-resistant schizophrenia. Despite this, numerous studies show under-utilisation, delayed access and reluctance by psychiatrists to prescribe clozapine. This retrospective cross-sectional study compared the prescribing of clozapine in two adult cohorts under the care of large public mental health services in Auckland (New Zealand) and Birmingham (United Kingdom) on 31 March 2007.
methodTime from first presentation to clozapine initiation, prior antipsychotics trialled and antipsychotic co-prescribing were compared. Data included demographics, psychiatric diagnosis, co-morbid conditions, year of first presentation, admissions and pharmacological treatment (clozapine dose, start date, prior antipsychotics, co-prescribed antipsychotic).
resultsOverall, 664 people were prescribed clozapine (402 Auckland; 262 Birmingham); mean daily dose of 384 mg (Auckland) and 429 mg (Birmingham). 53 % presented after 1990 and the average duration of time before starting clozapine was significantly longer in the Birmingham cohort (6.5 vs. 5.3 years) but this reduced in both cohorts to a 1-year mean in those presenting within the last 3 years. The average number of antipsychotics trialled pre-clozapine for those presenting since 1990 was significantly higher in the Birmingham cohort (4.3 vs. 3.1) but in both cohorts this similarly reduced in those presenting within the last 3 years. Antipsychotic co-prescribing was significantly higher in the Birmingham cohort (22.9 vs. 10.7 %).
conclusionsThere is evidence that access to clozapine has improved over time in both cohorts, with a reduction in the duration between presentation and initiation of clozapine and number of different antipsychotics trialled pre-clozapine. These are very positive findings in terms of optimising outcomes with clozapine and are possibly due to the impact of guideline recommendations, increasing clinician, consumer and carer knowledge, and experience with clozapine and funding changes.
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