ArticleThe Lancet regional health. Europe2026
Global trends in clozapine utilisation between 2014 and 2024: a longitudinal epidemiological study with data from 75 countries.
Article in The Lancet regional health. Europe, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
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Who cites it
5 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Clozapine prescribing in treatment-resistant schizophrenia - an updated systematic literature review of barriers and facilitators among clinicians.European journal of clinical pharmacology · 2026Pooled it
- Optimizing Management of Treatment-Resistant Schizophrenia in Japan: Promoting a Refined Clozapine Titration Protocol and Addressing the 'Clozapine Ceiling' through Glutamatergic Modulation.Psychiatry and clinical neurosciences · 2026Article
- Optimizing Clozapine Monitoring in Older Adults: A Proposal for Ethnicity- and Sex-Informed Monitoring in Japanese Geriatric Patients.Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society · 2026Article
- Relaxation of Japan's clozapine monitoring system is urgently needed: Adding 10,000 future prescriptions may prevent up to 400 schizophrenia-related suicides and cost 1 death by agranulocytosis.PCN reports : psychiatry and clinical neurosciences · 2026Article
- Prevalence of antipsychotic polypharmacy in patients with schizophrenia and other psychotic disorders in the MENAT and EMRO countries: a systematic review and meta-analysis.Frontiers in psychiatry · 2026Review
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Authors and funding
15 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Clozapine underutilisation in treatment-resistant schizophrenia represents a global public health challenge. We aimed to investigate contemporary trends of clozapine utilisation internationally. Methods: National estimates of clozapine utilisation were obtained for 75 countries through analysis of national prescribing databases and global pharmaceutical sales data from the IQVIA Multinational Integrated Data Analysis System. The annual national prevalence of clozapine utilisation was calculated between 2014 and 2024 via the number of defined daily doses (DDD) utilised per 1000 inhabitants per day (DDD/1000 inhabitants/day). Time trends in the annual prevalence of utilisation were tested using linear regression. Haematological monitoring stringency and the number of psychiatrists were explored as predictors of clozapine utilisation. Findings: In 2024, the global average clozapine utilisation was estimated as 0.46 DDD/1000 inhabitants/day, being greatest in New Zealand (2.99 DDD/1000 inhabitants/day), and Finland (2.61 DDD/1000 inhabitants/day) and lowest in Singapore (0.0007 DDD/1000 inhabitants/day). Over the period analysed, worldwide clozapine use increased by 0.13 DDD/1000 inhabitants/day. In 45 (60.0%) countries clozapine utilisation increased significantly, in 19 (25.3%) use remained similar, but in 11 (14.7%) use decreased significantly. Higher clozapine utilisation was associated with a higher number of psychiatrists (B = 0.11 [95% CI 0.05, 0.17]), but was unrelated to haematological monitoring stringency (B = 0.007 [95% CI -0.02, 0.03]). Interpretation: Whilst global utilisation appears increasing, substantial intercountry variation in clozapine use continues. The absence of an association between haematological monitoring stringency and rate of clozapine utilisation suggests the need for measures beyond monitoring relaxation within policy and practice to systematically increase use. Funding: Provided by St Patrick's Mental Health Services.
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