Effect of age on the relative efficacy of clozapine in schizophrenia.

Jones, Rowena and MacCabe, James H and Price, Malcolm James and Xiangxin, Liu and Upthegrove, Rachel (2020) Effect of age on the relative efficacy of clozapine in schizophrenia. Acta psychiatrica Scandinavica. ISSN 1600-0447. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

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Official URL: https://onlinelibrary.wiley.com/doi/abs/10.1111/ac...

Abstract

OBJECTIVE

Early treatment of schizophrenia improves outcomes. Clozapine appears to have unique benefit when other antipsychotic medication has failed. This systematic review and meta-analysis aims to assess clozapine's superiority over alternative antipsychotic medication and examine whether earlier use is associated with additional benefit.

METHOD

Systematic retrieval of blinded, randomized controlled trials comparing clozapine with alternative antipsychotics in adults with schizophrenia. The effect of mean age on relative clozapine response was examined using random effects meta-regression, and multiple linear regression on available patient data.

RESULTS

276 studies were retrieved. Thirty-four studies were included in the meta-analysis. Clozapine was significantly more effective than alternative antipsychotics in reducing psychotic symptoms and increasing response. However, meta-regression failed to show a more significant effect in younger patients (age on effect size (total psychotic symptoms) 0.00, p =0.79 CI -0.03 - 0.03). Individual patient data was available for 2 studies, the larger of which showed a significant interaction between younger age and superiority of clozapine.

CONCLUSION

The results support clozapine's superiority over other antipsychotics. A convincing effect of age on this effect was not demonstrated, although this was suggested in one study. In view of the age of many of the included studies, and changes in reporting practice over time, new clozapine RCTs, which include age of illness onset as well as age at trial time, would be welcome in order to provide meta-analysable data for future use.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: WM Psychiatry. Mental health
Divisions: Clinical Support > Pharmacy
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Depositing User: Mr Philip O'Reilly
Date Deposited: 31 Jan 2020 16:05
Last Modified: 31 Jan 2020 16:05
URI: http://www.repository.uhblibrary.co.uk/id/eprint/2821

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