Clozapine Treatment Is Associated With Higher Prescription Rate of Antipsychotic Monotherapy and Lower Prescription Rate of Other Concomitant Psychotropics: A Real-World Nationwide Study

Shinichiro Ochi, Hiromi Tagata, Naomi Hasegawa, Norio Yasui-Furukori, Jun Ichi Iga, Hiroko Kashiwagi, Fumitoshi Kodaka, Hiroshi Komatsu, Takashi Tsuboi, Akira Tokutani, Shusuke Numata, Kayo Ichihashi, Toshiaki Onitsuka, Hiroyuki Muraoka, Hitoshi Iida, Kazutaka Ohi, Kiyokazu Atake, Taishiro Kishimoto, Hikaru Hori, Yoshikazu TakaesuMasahiro Takeshima, Masahide Usami, Manabu Makinodan, Naoki Hashimoto, Michiko Fujimoto, Ryuji Furihata, Tatsuya Nagasawa, Hisashi Yamada, Junya Matsumoto, Kenichiro Miura, Mikio Kido, Akitoyo Hishimoto, Shu Ichi Ueno, Koichiro Watanabe, Ken Inada, Ryota Hashimoto

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)

Abstract

Background: Although clozapine is effective for treatment-resistant schizophrenia (TRS), the rate of clozapine prescription is still low. Whereas antipsychotic monotherapy is recommended in clinical practice guidelines, the rate of antipsychotic polypharmacy is still high. There is little evidence on whether a clozapine prescription influences changes in the rate of monotherapy and polypharmacy, including antipsychotics and other psychotropics. We therefore hypothesized that the rate of antipsychotic monotherapy in patients with TRS who were prescribed clozapine would be higher than that in patients with schizophrenia who were not prescribed clozapine. Methods: We assessed 8306 patients with schizophrenia nationwide from 178 institutions in Japan from 2016 to 2019. We analyzed the psychotropic prescription data at discharge in patients diagnosed with TRS and with no description of TRS (ND-TRS) based on the diagnosis listed in the discharge summary. Results: The rate of antipsychotic monotherapy in the TRS with clozapine group (91.3%) was significantly higher than that in the TRS without clozapine group (45.9%; P< 2.0 × 10−16) and the ND-TRS without clozapine group (54.7%; P< 2.0 × 10−16). The rate of antipsychotic monotherapy without any other concomitant psychotropics in the TRS with clozapine group (26.5%) was significantly higher than that in the TRS without clozapine group (12.6%; P= 1.1 × 10−6) and the ND-TRS without clozapine group (17.0%; P= 5.9 × 10−6). Conclusions: Clozapine prescription could be associated with a high rate of antipsychotic monotherapy. Patients will benefit from the correct diagnosis of TRS and thus from proper clozapine prescription.

Original languageEnglish
Pages (from-to)818-826
Number of pages9
JournalInternational Journal of Neuropsychopharmacology
Volume25
Issue number10
DOIs
Publication statusPublished - 2022 Oct 1

Keywords

  • EGUIDE
  • Treatment-resistant schizophrenia
  • guideline
  • lithium
  • polypharmacy

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