ArticleTherapeutic advances in psychopharmacology2021
Clozapine re-challenge and initiation following neutropenia: a review and case series of 14 patients in a high-secure forensic hospital.
Article in Therapeutic advances in psychopharmacology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 2 of them syntheses that pooled it.
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Who cites it
8 citing papers in PubMed, 2 syntheses or guidelines pooled it, 14 citations in OpenAlex.
- Clozapine Optimization: A Delphi Consensus Guideline From the Treatment Response and Resistance in Psychosis Working Group.Schizophrenia bulletin · 2023Guideline
- Clozapine rechallenge or continuation despite neutropenia or agranulocytosis using colony-stimulating factor: A systematic review.Journal of psychopharmacology (Oxford, England) · 2023Pooled it
- Late-Onset Neutropenia in Clozapine Users: Unrelated or Drug-Induced? A Case-Registry Analysis of Incidence, Characteristics, and Rechallenge Attempts.Schizophrenia bulletin · 2026Article
- Markers of neuroinflammation in the CSF of patients with difficult to treat psychiatric disease.Frontiers in psychiatry · 2026Article
- Understanding clozapine-related blood dyscrasias. Developments, genetics, ethnicity and disparity: it's a CIN.BJPsych bulletin · 2025Review
- Second to none: rationale, timing, and clinical management of clozapine use in schizophrenia.Therapeutic advances in psychopharmacology · 2023Review
- Clozapine use at a specialised psychiatric hospital in Johannesburg.The South African journal of psychiatry : SAJP : the journal of the Society of Psychiatrists of South Africa · 2023Article
- Distinctive pattern of neutrophil count change in clozapine-associated, life-threatening agranulocytosis.Schizophrenia (Heidelberg, Germany) · 2022Article
Corrections and comments
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Authors and funding
4 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveClozapine remains the most effective intervention for treatment resistant schizophrenia; however, its use is prohibited following neutropenias. We review neutrophil biology as applied to clozapine and describe the strategies to initiate clozapine following neutropenia used in a case series of 14 consecutive patients rechallenged in a United Kingdom (UK) high-secure psychiatric hospital. We examine outcomes including the use of seclusion and transfer.
methodsA case series of 14 male patients with treatment resistant schizophrenia treated with clozapine despite previous episodes of neutropenia between 2006 and 2015 is presented. Data were collected during 2015 and 2019. Using this routinely collected clinical data, we describe the patient characteristics, causes of neutropenia, the strategies used for rechallenging with clozapine and clinical outcomes.
resultsPrevious neutropenias were the result of benign ethnic neutropenia, clozapine, other medications and autoimmune-related. Our risk mitigation strategies included: granulocyte-colony stimulating factor (G-CSF), lithium and watch-and-wait. There were no serious adverse events; at follow up half of the patient's had improved sufficiently to transfer them to conditions of lesser security. There were dramatic reductions in the use of seclusion.
conclusionEven in this extreme group, clozapine can be safely and effectively re/initiated following neutropenias, resulting in marked benefits for patients. This requires careful planning based on an understanding of neutrophil biology and the aetiology of the specific episode of neutropenia.
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