Clinical response to clozapine in Black people with psychosis: A secondary analysis of an open-label clinical trial.

Background: Clozapine is the most effective treatment for people with treatment-resistant schizophrenia (TRS). However, clozapine is underutilized, and there are stark racial disparities: Black people with psychosis are less likely to receive clozapine than White people with psychosis. Because of the lack of data on the effectiveness of clozapine in Black people, we sought to determine the clinical response to clozapine in this population. Objectives: To evaluate clinical response to clozapine in Black people with psychosis to provide evidence that may help reduce disparities in clozapine access. Design: Secondary analysis of a six-month, prospective, open-label clinical trial examining the safety of clozapine use in Black people. Methods: We analyzed data from Black people with schizophrenia spectrum disorders ( Results: BPRS total scores decreased significantly with time on clozapine, with a mean reduction of 8.1 points across sites. BPRS positive and resistance subscale scores also improved significantly. Nigerian participants had higher odds of 30% BPRS improvement and showed a faster response to clozapine compared with USA participants. CGI-S improved significantly from baseline to 24 weeks, and weight increased significantly. Conclusions: Black participants experienced significant symptomatic benefit over 24 weeks on clozapine. These findings suggest that Black individuals eligible for clozapine may experience meaningful clinical improvement, supporting efforts to reduce disparities in clozapine access.