ArticleThe British journal of psychiatry : the journal of mental science2020
In the aftermath of clozapine discontinuation: comparative effectiveness and safety of antipsychotics in patients with schizophrenia who discontinue clozapine.
Article in The British journal of psychiatry : the journal of mental science, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
What it found
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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.
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Who cites it
19 citing papers in PubMed, 52 citations in OpenAlex.
- Article
- Clozapine-induced diarrhea: A case report and mechanistic overview.PCN reports : psychiatry and clinical neurosciences · 2026Article
- Understanding clozapine-related blood dyscrasias. Developments, genetics, ethnicity and disparity: it's a CIN.BJPsych bulletin · 2025Review
- A Case of Clozapine-Induced Hepatotoxicity: Management Considerations and Future Direction.Cureus · 2024Article
- Longitudinal changes in DNA methylation associated with clozapine use in treatment-resistant schizophrenia from two international cohorts.Translational psychiatry · 2024Article
- Review
- Discontinuation of psychotropic medication: a synthesis of evidence across medication classes.Molecular psychiatry · 2024Review
- Review
- Second to none: rationale, timing, and clinical management of clozapine use in schizophrenia.Therapeutic advances in psychopharmacology · 2023Review
- Clozapine haematological monitoring for neutropenia: a global perspective.Epidemiology and psychiatric sciences · 2022Review
- Genome-wide association analyses of symptom severity among clozapine-treated patients with schizophrenia spectrum disorders.Translational psychiatry · 2022Article
- Reducing the Risk of Withdrawal Symptoms and Relapse Following Clozapine Discontinuation-Is It Feasible to Develop Evidence-Based Guidelines?Schizophrenia bulletin · 2022Article
- Clozapine-induced myocarditis: electronic health register analysis of incidence, timing, clinical markers and diagnostic accuracy.The British journal of psychiatry : the journal of mental science · 2021Article
- Clozapine resistant schizophrenia: Newer avenues of management.World journal of psychiatry · 2021Review
- There Is Life After the UK Clozapine Central Non-Rechallenge Database.Schizophrenia bulletin · 2021Observational
- Clozapine re-challenge and initiation following neutropenia: a review and case series of 14 patients in a high-secure forensic hospital.Therapeutic advances in psychopharmacology · 2021Article
- Mandatory certification for clozapine prescribing.European psychiatry : the journal of the Association of European Psychiatrists · 2020Article
- Clozapine Combination and Augmentation Strategies in Patients With Schizophrenia -Recommendations From an International Expert Survey Among the Treatment Response and Resistance in Psychosis (TRRIP) Working Group.Schizophrenia bulletin · 2020Article
- Persistence of Antipsychotic Use After Clozapine Discontinuation: A Real-World Study Across Antipsychotics.Clinical and translational science · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 2 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAlthough clozapine is often discontinued, there is a paucity of guidelines and evidence on treatment options after clozapine discontinuation. Moreover, it is currently unknown whether reinstating clozapine in patients formerly using clozapine should be avoided.
aimsTo compare the real-world effectiveness of antipsychotics after clozapine cessation.
methodFrom Finnish registry data (1995-2017), we identified 2250 patients with schizophrenia who had been using clozapine for ≥1 year before treatment cessation. The primary analysis consisted of adjusted within-individual analyses of psychiatric ward readmission owing to psychosis and treatment failure. Secondary analyses concerned between-individual mortality differences.
resultsCompared with no use of antipsychotics, risk of psychiatric ward readmission was lowest for reinitiation of clozapine (adjusted hazard ratio (aHR) 0.49; 95% CI 0.40-0.61; P < 0.0001), oral olanzapine (aHR 0.58; 95% CI 0.48-0.71; P < 0.0001) and antipsychotic polypharmacy (aHR 0.62; 95% CI 0.53-0.72; P < 0.0001). Risk of treatment failure was lowest for aripiprazole long acting injectable (aHR 0.42; 95% CI 0.27-0.65; P < 0.0001), reinitiation of clozapine (aHR 0.49; 95% CI 0.43-0.57; P < 0.0001) and oral olanzapine (aHR 0.69; 95% CI 0.61-0.77; P < 0.0001). Mortality risk was lowest for reinitiation of clozapine (aHR 0.18; 95% CI 0.09-0.36; P < 0.0001) and oral olanzapine (aHR 0.26; 95% CI 0.17-0.40; P < 0.0001).
conclusionsClozapine and olanzapine are the most effective and safest treatment options in those discontinuing clozapine for undefined reasons. Clozapine should therefore be reconsidered in patients with schizophrenia who previously discontinued this compound.
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Registered trials
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